Healthcare Provider Details

I. General information

NPI: 1396664330
Provider Name (Legal Business Name): GROWTH AND SOLACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7355 123RD ST
SEMINOLE FL
33772-5514
US

IV. Provider business mailing address

7355 123RD ST
SEMINOLE FL
33772-5514
US

V. Phone/Fax

Practice location:
  • Phone: 727-888-4228
  • Fax:
Mailing address:
  • Phone: 727-888-4228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN BERG
Title or Position: OWNER
Credential: PHD, ABPP
Phone: 727-888-4228