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Organization
SPRUCE CREEK MENTAL HEALTH SERVICES, LLC
Active
Organization
SPRUCE CREEK MENTAL HEALTH SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD C KING LCSW (OWNER)
(386) 681-8639
Entity
Organization
Contact information
Practice address
1690 DUNLAWTON AVE, SUITE 125, PORT ORANGE, FL 32127-8979
(386) 681-8639
(386) 310-3992
Mailing address
6112 PALMAS DR, PORT ORANGE, FL 32127-6751
(386) 681-8639
(386) 310-3992
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW10520
FL
Other
Enumeration date
01/17/2013
Last updated
02/01/2013
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