Healthcare Provider Details

I. General information

NPI: 1538785837
Provider Name (Legal Business Name): CHANGE THE NARRATIVE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20417 BERRYWOOD LN
TAMPA FL
33647-3476
US

IV. Provider business mailing address

1936 BRUCE B DOWNS BLVD PMB 174
WESLEY CHAPEL FL
33544
US

V. Phone/Fax

Practice location:
  • Phone: 813-816-2766
  • Fax:
Mailing address:
  • Phone: 813-816-2766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. VINCENT MALIK DEHILI
Title or Position: LICENSED PSYCHOLOGIST
Credential: PHD
Phone: 386-852-8097