November Thea Church

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH11735 Issued in FL

Practice address

510 Vonderburg Dr
Suite 301
Brandon, FL 33511-5954

Phone

(813) 881-1000

Fax

(813) 689-2684

NPI assigned

Mar 28, 2013

Last updated

Mar 28, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Phoenix Programs of Florida, Inc.

  dba Phoenix Houses of Florida

  • Community/Behavioral Health Agency
  • Brandon, FL
  • NPI 1962542423
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1364428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364428800000",
    "number": "1972846814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 VONDERBURG DR",
            "address_2": "SUITE 301",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115954",
            "telephone_number": "813-881-1000",
            "fax_number": "813-689-2684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 VONDERBURG DR",
            "address_2": "SUITE 301",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115954",
            "telephone_number": "813-881-1000",
            "fax_number": "813-689-2684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHURCH",
        "first_name": "NOVEMBER",
        "middle_name": "THEA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-28",
        "last_updated": "2013-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH11735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Christian, MD
• James Leon Christopoulos, M.D.
• Katarzyna Chrostowski
• Pichai Chudhabuddhi Jr., LMT, CPT
• Lisa Katherine Church, PTA
• Nicole Marie Chuzie, RN
• Maureen Randall Cicatelli, M.S. CCC-SLP
• Alexander Vincent Ciccone
• Karlee Cicerchia
• Karen Michelle Cino, LCSW

• Mental Health Counselor in Brandon, FL
• Providers in Brandon, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.