Healthcare Provider Details

I. General information

NPI: 1376476044
Provider Name (Legal Business Name): DEBORAH METELLUS CHARLES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18002 ALLISON PARK PL APT 308
TAMPA FL
33647-2879
US

IV. Provider business mailing address

18002 ALLISON PARK PL APT 308
TAMPA FL
33647-2879
US

V. Phone/Fax

Practice location:
  • Phone: 305-834-3191
  • Fax:
Mailing address:
  • Phone: 305-834-3191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number26413
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: