Healthcare Provider Details

I. General information

NPI: 1437213097
Provider Name (Legal Business Name): ADIRONDACK SAMARITAN COUNSELING CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 03/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 BOULEVARD ST
HUDSON FALLS NY
12839-1001
US

IV. Provider business mailing address

15 BOULEVARD ST
HUDSON FALLS NY
12839-1001
US

V. Phone/Fax

Practice location:
  • Phone: 518-747-2994
  • Fax: 518-747-2996
Mailing address:
  • Phone: 518-747-2994
  • Fax: 518-747-2996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DOUGLAS STEPHENS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 518-747-2994