Provider Demographics
NPI:1538785837
Name:CHANGE THE NARRATIVE COUNSELING LLC
Entity type:Organization
Organization Name:CHANGE THE NARRATIVE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:MALIK
Authorized Official - Last Name:DEHILI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:386-852-8097
Mailing Address - Street 1:1936 BRUCE B DOWNS BLVD
Mailing Address - Street 2:PMB 174
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544
Mailing Address - Country:US
Mailing Address - Phone:813-816-2766
Mailing Address - Fax:
Practice Address - Street 1:20417 BERRYWOOD LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3476
Practice Address - Country:US
Practice Address - Phone:813-816-2766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty