Edward Cecil King, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

10520 Issued in FL

Practice address

1690 Dunlawton Ave
Suite 125
Port Orange, FL 32127-8979

Phone

(386) 236-9271

NPI assigned

Oct 8, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles (1 of 2)

Networks

• Freedom Health HMO Network

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Spruce Creek Mental Health Services, LLC

  • Clinical Social Worker
  • Port Orange, FL
  • NPI 1669710273
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655164800000",
    "number": "1659623213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6112 PALMAS DR",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321276751",
            "telephone_number": "386-236-9271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1690 DUNLAWTON AVE",
            "address_2": "SUITE 125",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321278979",
            "telephone_number": "386-236-9271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "EDWARD",
        "middle_name": "CECIL",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-08",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "10520",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "10520",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "023145400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Mark Kim, DDS
• Kirsten S. Kim, M.D.
• Leonard Kim
• Amanda Kimbler
• Carson King, PT, DPT
• Eric King
• Meagan King
• Shannon Marie King, LCSWC
• Gregory T Kipp, O.D.
• Pamela Kirby, D.P.M.

• Mental Health Counselor in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.