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General NPI Number Information
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NPI Number | 1598426074
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Entity Type | Organization
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Legal Business Name | DIVERSITY HEALTH SERVICES INC
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Dates
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Enumeration Date | 01/06/2022
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 10668 NEW EAST BAY DR
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City | GIBSONTON
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State | FL
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Zip | 33534-5028
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Country | US
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Telephone | 813-808-4089
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Fax |
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Provider Business Mailing Address
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Address Line | 10413 HAMPTON MEADOW WAY
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City | RIVERVIEW
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State | FL
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Zip | 33578-3406
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Country | US
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Telephone | 803-808-4089
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CAROLYN REDMOND
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Credential | LCSW
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Telephone | 813-808-4089
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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 |
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License Number State |
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