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General NPI Number Information
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NPI Number | 1073058921
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Entity Type | Organization
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Legal Business Name | COUNSELING ASSOCIATES OF TAMPA BAY, LLC
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Dates
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Enumeration Date | 01/02/2017
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Last Update Date | 01/02/2017
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Provider Practice Location Address
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Address Line | 11736 NEWBERRY GROVE LOOP
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City | RIVERVIEW
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State | FL
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Zip | 33579-3902
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Country | US
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Telephone | 908-415-0632
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Fax |
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Provider Business Mailing Address
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Address Line | 11736 NEWBERRY GROVE LOOP
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City | RIVERVIEW
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State | FL
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Zip | 33579-3902
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Country | US
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Telephone | 908-415-0632
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. TIMOTHY WEAVER
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Credential | LMHC
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Telephone | 908-415-0632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH9939
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License Number State | FL
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