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General NPI Number Information
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NPI Number | 1053033514
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Entity Type | Individual
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Provider Name | SHAHEDRA WARD-KING
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Gender | Female
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 582 SE 7TH AVE STE B
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-4840
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Country | US
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Telephone | 352-228-8829
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Fax |
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Provider Business Mailing Address
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Address Line | 3350 SE US HIGHWAY 41 UNIT 473
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City | MORRISTON
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State | FL
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Zip | 32668-3352
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Country | US
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Telephone | 845-633-3466
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101200000X
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Taxonomy Name | Drama Therapist
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License Number |
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License Number State |
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