Organization
CHILD AND FAMILY LEARING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIANE ABBY KOCH PH.D. (OWNER/DIRECTOR)
(813) 399-1625
Entity
Organization
Contact information
Practice address
16105 CADBURY CT, TAMPA, FL 33647-1135
(813) 399-1625
Mailing address
10549 N FLORIDA AVE STE G, TAMPA, FL 33612-6707
(813) 399-1625
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY0004230
FL
Other
Enumeration date
10/20/2014
Last updated
10/20/2014
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