Provider Demographics
NPI:1598157489
Name:HARGRAVE, DINA (MS, EDS, LMHC, CMHC)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:HARGRAVE
Suffix:
Gender:F
Credentials:MS, EDS, LMHC, CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 GALILEO DR STE 102
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1852
Mailing Address - Country:US
Mailing Address - Phone:727-261-0508
Mailing Address - Fax:727-616-4707
Practice Address - Street 1:3636 GALILEO DR STE 102
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1852
Practice Address - Country:US
Practice Address - Phone:727-261-0508
Practice Address - Fax:727-616-4707
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9498105-6004101YM0800X, 101YM0800X
FLMH23154101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health