Healthcare Provider Details

I. General information

NPI: 1205527660
Provider Name (Legal Business Name): VERONICA GREEN RCMHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7819 N DALE MABRY HWY STE 108
TAMPA FL
33614-3210
US

IV. Provider business mailing address

7819 N DALE MABRY HWY STE 108
TAMPA FL
33614-3210
US

V. Phone/Fax

Practice location:
  • Phone: 813-308-9449
  • Fax:
Mailing address:
  • Phone: 813-538-0149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH21547
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: