Individual ProviderNovember Thea ChurchCounselorBehavioral Health & Social Service ProvidersPractice Address510 Vonderburg Dr, Suite 301, Brandon, FL 33511-5954(813) 881-1000PECOS EnrollmentBased on the most recent information from CMS, provider November Thea Church does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 11:06 AM.Profile DetailsProvider ID1972846814Provider TypeIndividualFull NameChurch, November TheaGenderFemaleSole ProprietorNoEnumeration Date3/28/2013Last Updated3/28/2013Contact InformationPractice LocationPractice Address510 Vonderburg Dr, Suite 301, Brandon, FL 33511-5954Phone(813) 881-1000Fax(813) 689-2684Mailing LocationMailing Address510 Vonderburg Dr, Suite 301, Brandon, FL 33511-5954Phone(813) 881-1000Fax(813) 689-2684Provider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseMH11735Florida