=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760368625
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUMBLE HYDRATIONS MENTAL WELLNESS & GROWTH, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2025
-----------------------------------------------------
Last Update Date | 08/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3110 1ST AVE N SUITE 2M
-----------------------------------------------------
City | SAINT PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33713-3635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-314-5157
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2850 34TH ST N # 1276
-----------------------------------------------------
City | SAINT PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33713-3635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-314-5157
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. AQUINETTA NELSON
-----------------------------------------------------
Credential | MA, LMHC
-----------------------------------------------------
Telephone | 727-712-7692
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------