Healthcare Provider Details

I. General information

NPI: 1326960816
Provider Name (Legal Business Name): WILDFLOWER MENTAL HEALTH COUNSELING SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 BELL BLVD STE A1
BAYSIDE NY
11361-2168
US

IV. Provider business mailing address

21337 39TH AVE # 225
BAYSIDE NY
11361-2071
US

V. Phone/Fax

Practice location:
  • Phone: 631-987-4193
  • Fax:
Mailing address:
  • Phone: 631-987-4193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ALYSSA DIPADOVA
Title or Position: LMHC
Credential:
Phone: 631-987-4193