Healthcare Provider Details

I. General information

NPI: 1558089425
Provider Name (Legal Business Name): TRINITY COUNSELING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 LITTLE RD
TRINITY FL
34655-5365
US

IV. Provider business mailing address

1540 LITTLE RD
TRINITY FL
34655-5365
US

V. Phone/Fax

Practice location:
  • Phone: 727-268-8729
  • Fax:
Mailing address:
  • Phone: 727-268-8729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARY J. VAZQUEZ
Title or Position: CLINICAL DIRECTOR
Credential: LMHC
Phone: 727-268-8750