Provider Demographics
NPI:1801377189
Name:PETTY, META LASHON (LCSW)
Entity Type:Individual
Prefix:
First Name:META
Middle Name:LASHON
Last Name:PETTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:META
Other - Middle Name:LASHON
Other - Last Name:PETTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:META L PETTY, LCSW
Mailing Address - Street 1:14924 CASEY RD UNIT 3B
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-2317
Mailing Address - Country:US
Mailing Address - Phone:813-492-9241
Mailing Address - Fax:
Practice Address - Street 1:14924 CASEY RD UNIT 3B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-2317
Practice Address - Country:US
Practice Address - Phone:813-492-9241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW152801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW15280OtherFLORIDA DEPARTMENT OF HEALTH