Healthcare Provider Details

I. General information

NPI: 1003677865
Provider Name (Legal Business Name): IN HER HANDS GROUP HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37312 MAIN AVE
DADE CITY FL
33523-3026
US

IV. Provider business mailing address

37312 MAIN AVE
DADE CITY FL
33523-3026
US

V. Phone/Fax

Practice location:
  • Phone: 813-713-5538
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: K'BRIA CHARLOTIN
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 404-337-7068