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General NPI Number Information
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NPI Number | 1922638857
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Entity Type | Organization
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Legal Business Name | VITA NOVA COUNSELING PLLC
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Dates
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Enumeration Date | 01/20/2020
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Last Update Date | 03/23/2020
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Provider Practice Location Address
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Address Line | 14001 W STATE HIGHWAY 29 STE 201
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City | LIBERTY HILL
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State | TX
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Zip | 78642-2251
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Country | US
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Telephone | 915-861-7280
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Fax |
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Provider Business Mailing Address
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Address Line | 14001 W STATE HIGHWAY 29 STE 201
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City | LIBERTY HILL
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State | TX
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Zip | 78642-2251
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ERICA THOMAS
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Credential |
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Telephone | 915-887-3410
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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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