Individual
CHARLES CARBALLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY D
Contact information
Practice address
2403 CORRINE ST, TAMPA, FL 33605-6540
(813) 298-9974
Mailing address
2403 CORRINE ST, TAMPA, FL 33605-6540
(813) 298-9974
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C614143654080
FLORIDA DRIVERS LICENSE
—
Enumeration date
01/19/2011
Last updated
01/19/2011
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