Healthcare Provider Details

I. General information

NPI: 1396191441
Provider Name (Legal Business Name): STEPHANIE KING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2016
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 BISCAYNE BLVD STE 800
NORTH MIAMI FL
33181-2726
US

IV. Provider business mailing address

PMB 1066, 3408 S ATLANTIC AVE
DAYTONA BEACH FL
32118
US

V. Phone/Fax

Practice location:
  • Phone: 386-287-2822
  • Fax:
Mailing address:
  • Phone: 386-287-2822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH17312
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: