Healthcare Provider Details

I. General information

NPI: 1619201456
Provider Name (Legal Business Name): CV/COUNSELING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2009
Last Update Date: 07/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 4TH AVE SW
LARGO FL
33770-3413
US

IV. Provider business mailing address

417 4TH AVE SW
LARGO FL
33770-3413
US

V. Phone/Fax

Practice location:
  • Phone: 727-608-7286
  • Fax: 727-585-9647
Mailing address:
  • Phone: 727-608-7286
  • Fax: 727-585-9647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT2433
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMH8574
License Number StateFL

VIII. Authorized Official

Name: MR. CHARLES V SMITH
Title or Position: CEO
Credential: LMHC, LMFT, MAC, SAP
Phone: 727-608-7286