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General NPI Number Information
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NPI Number | 1235517392
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Entity Type | Organization
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Legal Business Name | TGA COUNSELING LLC
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Dates
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Enumeration Date | 05/09/2015
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Last Update Date | 03/30/2020
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Provider Practice Location Address
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Address Line | 11820 MIRAMAR PARKWAY SUITE 224
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City | MIRAMAR
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State | FL
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Zip | 33025
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Country | US
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Telephone | 954-366-9842
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Fax |
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Provider Business Mailing Address
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Address Line | 5825 SWORDFISH CT UNIT A
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City | TAMARAC
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State | FL
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Zip | 33319
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Country | US
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Telephone | 954-829-6144
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TRICIA ANTONIO
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Credential | LCSW
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Telephone | 954-829-6144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW9260
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License Number State | FL
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