Organization
COUNSELING & WELLNESS BOUTIQUE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAINA THORPE LCSW (CLINICAL DIRECTOR)
(813) 591-4868
Entity
Organization
Contact information
Practice address
1503 S US HIGHWAY 301 STE E16, TAMPA, FL 33619-5126
(813) 591-4868
(813) 279-2551
Mailing address
11705 BOYETTE RD # 248, RIVERVIEW, FL 33569-5533
(813) 591-4868
(813) 279-2551
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
05/01/2018
Last updated
08/30/2019
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