Healthcare Provider Details

I. General information

NPI: 1134656564
Provider Name (Legal Business Name): HIGHER LIFE PATHWAYS MENTAL HEALTH COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 05/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6143 186TH ST
FRESH MEADOWS NY
11365-2710
US

IV. Provider business mailing address

PO BOX 280735
QUEENS VILLAGE NY
11428-0735
US

V. Phone/Fax

Practice location:
  • Phone: 516-268-0064
  • Fax:
Mailing address:
  • Phone: 516-268-0064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005132
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00459100
License Number StateNJ

VIII. Authorized Official

Name: DR. DINELLY HOLDER
Title or Position: DIRECTOR
Credential: PHD, NCC, CCMHC
Phone: 516-268-0064