MEDICARE: DREAVITA COUNSELING COACHING AND CONSULTING INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103TB0200X	Cognitive & Behavioral Psychologist
3	103TC0700X	Clinical Psychologist
4	103TC1900X	Counseling Psychologist
5	261QC1800X	Corporate Health Clinic/Center
6	390200000X	Student in an Organized Health Care Education/Training Program
7	103TM1800X	Intellectual & Developmental Disabilities Psychologist
8	103TP2701X	Group Psychotherapy Psychologist
9	104100000X	Social Worker
10	1041C0700X	Clinical Social Worker
11	171400000X	Health & Wellness Coach
12	251V00000X	Voluntary or Charitable Agency
13	101Y00000X	Counselor

General Provider Information

NPI Number	:	1104694116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DREAVITA COUNSELING COACHING AND CONSULTING INC

Provider Business Mailing Address
First Line	:	3911 CONCORD PIKE UNIT 8030
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19803-6044
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1227 N GENESEE AVE APT 5
Second Line	:
City	:	W HOLLYWOOD
State	:	CA
Zip	:	90046-4730
Country	:	US
Telephone Number	:	813-690-5092
Fax Number	:

Authorized Official
Title or Position	:	CEO/EXECUTIVE DIRECTOR
Name	:	ANDREA PIAZZA
Credential	:	LMHC
Telephone Number	:	813-690-5092

Provider Enumeration Date	:	12/19/2023
Last Update Date	:	12/19/2023

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