Provider Demographics
NPI:1609511955
Name:KING, SHIRLEY W (MA, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:W
Last Name:KING
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 PHILIPS HWY STE 11
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6082
Mailing Address - Country:US
Mailing Address - Phone:904-239-3677
Mailing Address - Fax:908-866-4029
Practice Address - Street 1:6950 PHILIPS HWY STE 11
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6082
Practice Address - Country:US
Practice Address - Phone:904-239-3677
Practice Address - Fax:908-866-4029
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH20739101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH20739OtherFL DOH