Provider Demographics
NPI:1881116374
Name:REDEFINE YOUR STORY, LLC
Entity type:Organization
Organization Name:REDEFINE YOUR STORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:STEELE-TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-483-1331
Mailing Address - Street 1:3707 POMPANO DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-4736
Mailing Address - Country:US
Mailing Address - Phone:850-483-1331
Mailing Address - Fax:850-361-3437
Practice Address - Street 1:3707 POMPANO DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-4736
Practice Address - Country:US
Practice Address - Phone:850-483-1331
Practice Address - Fax:850-361-3437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW115911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1184050197OtherSTACEY STEELE-TAYLOR