Healthcare Provider Details

I. General information

NPI: 1457728172
Provider Name (Legal Business Name): ADIRONDACK COMMUNITY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 BERNARD STREET
SARANAC LAKE NY
12983
US

IV. Provider business mailing address

165 NEIL ST
SARANAC LAKE NY
12983-1565
US

V. Phone/Fax

Practice location:
  • Phone: 518-420-6023
  • Fax:
Mailing address:
  • Phone: 518-420-6023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number005895
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number005895
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number005895
License Number StateNY

VIII. Authorized Official

Name: DANIELLE CARR
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: LMHC, NCC
Phone: 518-420-6023