Healthcare Provider Details

I. General information

NPI: 1790191781
Provider Name (Legal Business Name): CARING COMMUNITY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 5TH AVE N
SAINT PETERSBURG FL
33713-7521
US

IV. Provider business mailing address

3840 5TH AVE N
SAINT PETERSBURG FL
33713-7521
US

V. Phone/Fax

Practice location:
  • Phone: 727-367-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH12478
License Number StateFL

VIII. Authorized Official

Name: DR. WANDA BARNES
Title or Position: DIRECTOR
Credential:
Phone: 727-367-2273