Healthcare Provider Details

I. General information

NPI: 1275049884
Provider Name (Legal Business Name): JUST 4 YOU FAMILY SUPPORT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 JOHNSON AVE STE 2
BOHEMIA NY
11716-2690
US

IV. Provider business mailing address

608 JOHNSON AVE STE 2
BOHEMIA NY
11716-2690
US

V. Phone/Fax

Practice location:
  • Phone: 631-575-8062
  • Fax:
Mailing address:
  • Phone: 631-575-8062
  • Fax: 631-761-9475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. KENRICK ALFRED
Title or Position: CHAIRMAN OF THE BOARD
Credential: CASAC-T, CAMS II
Phone: 631-575-8062