Healthcare Provider Details

I. General information

NPI: 1871572875
Provider Name (Legal Business Name): 30-A THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 UPTOWN GRAYTON CIR SUITE B
SANTA ROSA BEACH FL
32459-5890
US

IV. Provider business mailing address

57 UPTOWN GRAYTON CIR SUITE B
SANTA ROSA BEACH FL
32459-5890
US

V. Phone/Fax

Practice location:
  • Phone: 850-534-3086
  • Fax: 850-534-3081
Mailing address:
  • Phone: 850-534-3086
  • Fax: 850-534-3081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. ANN PLAUCHE LIRETTE
Title or Position: OWNER PRESIDENT
Credential: LCSW
Phone: 850-534-3086