Healthcare Provider Details

I. General information

NPI: 1508409319
Provider Name (Legal Business Name): TAMPA BAY AREA COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16502 N DALE MABRY HWY
TAMPA FL
33618-1325
US

IV. Provider business mailing address

2868 LIVING CORAL DR
ODESSA FL
33556-5123
US

V. Phone/Fax

Practice location:
  • Phone: 727-732-4305
  • Fax:
Mailing address:
  • Phone: 813-601-0595
  • Fax: 727-499-7888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARISSE DIAZ
Title or Position: CEO
Credential: PSYD LMHC
Phone: 813-601-0595