Healthcare Provider Details

I. General information

NPI: 1588534572
Provider Name (Legal Business Name): MR. JOSHUA MARK KING III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 E MOUND ST
JACKSON OH
45640-1226
US

IV. Provider business mailing address

460 S WISCONSIN AVE
WELLSTON OH
45692-1629
US

V. Phone/Fax

Practice location:
  • Phone: 740-577-3834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number195377
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: