King, Shannon Marie

King, Shannon Marie is an sole proprietor health care provider with primary practice located at 1690 Dunlawton Ave Ste 125 , Port Orange FL 32127-8980. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. King, Shannon Marie can be contacted via phone (240) 818-9499.

Contact Information

Primary practice address
1690 Dunlawton Ave Ste 125 Port Orange FL 32127-8980
Phone: (240) 818-9499
Fax: (386) 310-3992
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 15689 Maryland
Behavioral Health & Social Service Providers / Clinical 1041C0700X SW 10086 Florida

Profile Details

NPI number 1902048176
LBN Legal business name King, Shannon Marie
Credentials LCSWC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 2nd, 2009
Last updated Apr 2nd, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902048176 NPPES
Florida Other Z04FN FLORIDA BLUE
Florida MEDICAID 023156600 FLORIDA BLUE

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