Healthcare Provider Details

I. General information

NPI: 1679491989
Provider Name (Legal Business Name): TEEN DEVELOPMENT AND COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

13801 N DALE MABRY HWY
TAMPA FL
33618-2412
US

IV. Provider business mailing address

13801 N DALE MABRY HWY
TAMPA FL
33618-2412
US

V. Phone/Fax

Practice location:
  • Phone: 813-492-4674
  • Fax:
Mailing address:
  • Phone: 813-492-4674
  • Fax:

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: MELISSA BRONER
Title or Position: OWNER, THERAPIST
Credential:
Phone: 813-492-4674