Healthcare Provider Details

I. General information

NPI: 1073249728
Provider Name (Legal Business Name): FELLOWSHIP RESOURCES CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 AVENUE P
BROOKLYN NY
11204-4946
US

IV. Provider business mailing address

249 AVENUE P
BROOKLYN NY
11204-4946
US

V. Phone/Fax

Practice location:
  • Phone: 929-321-2290
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: ASHRAF A SHARHAN
Title or Position: PRESIDENT
Credential:
Phone: 929-321-2290