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General NPI Number Information
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NPI Number | 1780206029
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Entity Type | Organization
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Legal Business Name | THAT'S CRAZY, LLC
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Dates
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Enumeration Date | 05/09/2020
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 330 PAULS DR STE 105
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City | BRANDON
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State | FL
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Zip | 33511-4801
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Country | US
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Telephone | 321-948-4336
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Fax |
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Provider Business Mailing Address
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Address Line | 12015 STONE PINE ST
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City | RIVERVIEW
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State | FL
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Zip | 33569-5588
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Country | US
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Telephone | 321-948-4336
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | MRS. ASHLEY RAYSHELLE LUCAS
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Credential |
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Telephone | 813-400-3212
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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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