Provider Demographics
NPI:1447382957
Name:SOUTH TAMPA COUNSELING ASSOCIATES
Entity Type:Organization
Organization Name:SOUTH TAMPA COUNSELING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGORISCH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:813-350-9490
Mailing Address - Street 1:3839 W KENNEDY BLVD
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2719
Mailing Address - Country:US
Mailing Address - Phone:813-350-9490
Mailing Address - Fax:813-877-3839
Practice Address - Street 1:3839 W KENNEDY BLVD
Practice Address - Street 2:SUITE ONE
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2719
Practice Address - Country:US
Practice Address - Phone:813-350-9490
Practice Address - Fax:813-877-3839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW45091041C0700X
FLMT1697106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty