Provider Demographics
NPI:1104519909
Name:FRIEDLE, CECILIA KIM (LCSW)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:KIM
Last Name:FRIEDLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 YALE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-3340
Mailing Address - Country:US
Mailing Address - Phone:386-488-1159
Mailing Address - Fax:
Practice Address - Street 1:730 BEVILLE RD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-5933
Practice Address - Country:US
Practice Address - Phone:386-488-1159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW21341101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor