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General NPI Number Information
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NPI Number | 1417373242
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Entity Type | Organization
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Legal Business Name | POSITIVE TRANSFORMATIONS PA
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Dates
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Enumeration Date | 03/18/2014
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Last Update Date | 03/18/2014
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Provider Practice Location Address
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Address Line | 10021 WATER WORKS LN
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City | RIVERVIEW
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State | FL
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Zip | 33578-5304
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Country | US
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Telephone | 813-677-6444
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Fax | 813-677-7999
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Provider Business Mailing Address
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Address Line | 10021 WATER WORKS LN
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City | RIVERVIEW
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State | FL
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Zip | 33578-5304
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Country | US
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Telephone | 813-677-6444
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Fax | 813-677-7999
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. ANDREA CHRISTINE THATCHER
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Credential | PSY.D.
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Telephone | 813-677-6444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY 8912
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License Number State | FL
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