Organization
IMPACT TRAUMA COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN G WOLSTEIN DC (OWNER)
(727) 906-7221
Entity
Organization
Contact information
Practice address
2701 PARK DR STE 2AND7, CLEARWATER, FL 33763-1021
(727) 906-7221
Mailing address
PO BOX 7982, SEMINOLE, FL 33775-7982
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123
NONE
FL
01
—
NONE
NONE
—
Enumeration date
03/07/2023
Last updated
03/07/2023
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