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General NPI Number Information
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NPI Number | 1124982244
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Entity Type | Organization
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Legal Business Name | VITA THERAPY GROUP
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Dates
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Enumeration Date | 12/12/2025
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 7901 4TH STREET NORTH STE 300
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City | SAINT PETERSBURG
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State | FL
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Zip | 33702
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Country | US
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Telephone | 319-804-9979
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Fax | 319-289-7023
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Provider Business Mailing Address
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Address Line | 5249 N PARK PL NE # 1018
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City | CEDAR RAPIDS
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State | IA
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Zip | 52402-6210
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Country | US
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Telephone | 319-804-9979
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Fax | 319-289-7023
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | MRS. SHANNON ELISE PEREA
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Credential | LMHC
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Telephone | 319-804-9979
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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 |
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License Number State |
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