Healthcare Provider Details

I. General information

NPI: 1255119640
Provider Name (Legal Business Name): THERAPY CAFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 09/18/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4522 W VILLAGE DR UNIT 1246
TAMPA FL
33624-3429
US

IV. Provider business mailing address

35 DUKE ST UNIT 763
PRINCE FREDERICK MD
20678-7528
US

V. Phone/Fax

Practice location:
  • Phone: 443-295-8955
  • Fax: 888-883-1589
Mailing address:
  • Phone: 443-295-8955
  • Fax: 888-883-1589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALLISON STENSON
Title or Position: CFO
Credential:
Phone: 443-295-8955