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General NPI Number Information
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NPI Number | 1346669876
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Entity Type | Organization
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Legal Business Name | DIVASILE ENTERPRISES, INC.
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Dates
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Enumeration Date | 04/11/2014
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Last Update Date | 04/11/2014
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Provider Practice Location Address
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Address Line | 1698 S BELCHER RD ROOM 5
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City | CLEARWATER
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State | FL
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Zip | 33764-6517
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Country | US
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Telephone | 727-278-5757
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Fax | 866-266-6555
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Provider Business Mailing Address
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Address Line | PO BOX 285
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City | DUNEDIN
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State | FL
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Zip | 34697-0285
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Country | US
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Telephone | 727-278-5757
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Fax | 866-266-6555
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Authorized Official
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Title or Position | CEO
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Name | MS. MARIE ELISA DILLINGER-VASILE
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Credential | LMHC
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Telephone | 727-278-5757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | MH10875
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License Number State | FL
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