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General NPI Number Information
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NPI Number | 1902048176
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Entity Type | Individual
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Provider Name | SHANNON MARIE KING LCSWC
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Gender | Female
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Dates
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Enumeration Date | 04/02/2009
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 6069 SPRUCE POINT CIR
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City | PORT ORANGE
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State | FL
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Zip | 32128-5508
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Country | US
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Telephone | 240-818-9499
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Fax | 213-283-7741
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Provider Business Mailing Address
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Address Line | 6069 SPRUCE POINT CIR
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City | PORT ORANGE
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State | FL
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Zip | 32128-5508
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Country | US
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Telephone | 240-818-9499
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW 10086
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 15689
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License Number State | MD
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