Healthcare Provider Details

I. General information

NPI: 1972938967
Provider Name (Legal Business Name): GROWTH & RECOVERY COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7747 MITCHELL BLVD STE. B
TRINITY FL
34655-4725
US

IV. Provider business mailing address

7747 MITCHELL BLVD STE. B
TRINITY FL
34655-4725
US

V. Phone/Fax

Practice location:
  • Phone: 727-267-6247
  • Fax: 888-878-0546
Mailing address:
  • Phone: 727-267-6247
  • Fax: 888-878-0546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW9562
License Number StateFL

VIII. Authorized Official

Name: MRS. JOY DAVIS VINCENT
Title or Position: OWNER, SENIOR THERAPIST
Credential: LCSW
Phone: 727-267-6247