Provider Demographics
NPI:1396169819
Name:SUPPORTIVE THERAPY EMPOWERING PEOPLE, PLLC
Entity type:Organization
Organization Name:SUPPORTIVE THERAPY EMPOWERING PEOPLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:
Authorized Official - Last Name:VILMENAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-892-6203
Mailing Address - Street 1:220 W BRANDON BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5104
Mailing Address - Country:US
Mailing Address - Phone:813-892-6203
Mailing Address - Fax:813-381-3909
Practice Address - Street 1:220 W BRANDON BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5104
Practice Address - Country:US
Practice Address - Phone:813-892-6203
Practice Address - Fax:813-381-3909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9398101YM0800X
FLSW84251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty