Organization
WINGATE DE ACADEMY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. QETSIYAH S YISRAE PHD (NON LICENSE COUNSELOR)
(813) 693-9449
Entity
Organization
Contact information
Practice address
2780 E FOWLER AVE # 174, TAMPA, FL 33612-6297
(813) 359-9569
(813) 671-8825
Mailing address
2780 E FOWLER AVE # 174, TAMPA, FL 33612-6297
(813) 359-9569
(813) 671-8825
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
09/17/2018
Last updated
09/17/2018
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