Healthcare Provider Details

I. General information

NPI: 1699657023
Provider Name (Legal Business Name): MARRIED TO AN ADDICT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 07/25/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7608 LANCELOT RD
PORT RICHEY FL
34668-2635
US

IV. Provider business mailing address

PO BOX 572
PORT RICHEY FL
34673-0572
US

V. Phone/Fax

Practice location:
  • Phone: 727-265-2356
  • Fax:
Mailing address:
  • Phone: 727-265-2356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JENELLA JENESE BROWN
Title or Position: SUBSTANCE ABUSE COUNSELOR
Credential: MCAP, RMHCI
Phone: 727-265-2356