Healthcare Provider Details

I. General information

NPI: 1215503313
Provider Name (Legal Business Name): THERAPEUTIC COUNSELING SUPPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2021
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 SHORT BRANCH DR STE 103
NEW PORT RICHEY FL
34655-4423
US

IV. Provider business mailing address

18530 HUNTERS MEADOW WALK
LAND O LAKES FL
34638-0044
US

V. Phone/Fax

Practice location:
  • Phone: 813-699-0886
  • Fax:
Mailing address:
  • Phone: 813-699-0886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE SANDY
Title or Position: SOLE MEMBER
Credential: M.S, LMHC
Phone: 813-699-0886