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General NPI Number Information
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NPI Number | 1104519909
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Entity Type | Individual
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Provider Name | CECILIA KIM FRIEDLE LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/30/2023
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 730 BEVILLE RD
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-5933
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Country | US
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Telephone | 386-488-1159
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Fax |
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Provider Business Mailing Address
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Address Line | 2640 YALE RD
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City | SOUTH DAYTONA
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State | FL
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Zip | 32119-3340
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Country | US
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Telephone | 386-488-1159
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | SW21341
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License Number State | FL
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