Provider Demographics
NPI:1871572875
Name:30-A THERAPY INC
Entity type:Organization
Organization Name:30-A THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:PLAUCHE
Authorized Official - Last Name:LIRETTE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-534-3086
Mailing Address - Street 1:57 UPTOWN GRAYTON CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-5890
Mailing Address - Country:US
Mailing Address - Phone:850-534-3086
Mailing Address - Fax:850-534-3081
Practice Address - Street 1:57 UPTOWN GRAYTON CIR
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-5890
Practice Address - Country:US
Practice Address - Phone:850-534-3086
Practice Address - Fax:850-534-3081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty