Spruce Creek Counseling, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

SPRUCE CREEK COUNSELING, LLC

Practice address

6069 Spruce Point Cir
Port Orange, FL 32128-5508

Phone

(240) 818-9499

NPI assigned

Feb 7, 2025

Organization subpart

No

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

Authorized official

Name

Shannon Marie King, LCSWNPI 1902048176

Title

Owner/Manager

Phone

(240) 818-9499

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shannon Marie King, LCSWC

  • Clinical Social Worker
  • Port Orange, FL
  • NPI 1902048176
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1738886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772582400000",
    "number": "1942014055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6069 SPRUCE POINT CIR",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321285508",
            "telephone_number": "240-818-9499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6069 SPRUCE POINT CIR",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321285508",
            "telephone_number": "240-818-9499"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5889 S Williamson Blvd Ste 1431",
            "address_purpose": "LOCATION",
            "city": "Port Orange",
            "state": "FL",
            "postal_code": "321287499",
            "country_code": "US",
            "telephone_number": "240-818-9499",
            "fax_number": "213-283-7741",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPRUCE CREEK COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-07",
        "last_updated": "2026-03-04",
        "certification_date": "2026-03-04",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "240-818-9499",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sufian Jabbar Sorathia, M.D.
• Vickie Lynn Sorrell, FNP-BC
• Sovereign Healthcare of Port Orange, LLC
• Space Coast Spine LLC.
• Deanna Kingsley Springer, M.D.
• Spruce Creek Family Care
• Spruce Creek Mental Health Services, LLC
• Spruce Dental, LLC
• Anunporn Srisawat, M.D.
• Shannon St Amant, D.C.

• Community/Behavioral Health Agency in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Community/Behavioral Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.