Healthcare Provider Details

I. General information

NPI: 1023366630
Provider Name (Legal Business Name): DEBOLINA GHOSH M.A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005A CHINABERRY DR
COLUMBIA MO
65201-3550
US

IV. Provider business mailing address

12512 BRUCE B DOWNS BLVD
TAMPA FL
33612-9209
US

V. Phone/Fax

Practice location:
  • Phone: 573-874-8818
  • Fax: 573-874-8818
Mailing address:
  • Phone: 813-977-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2024039339
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: