Healthcare Provider Details

I. General information

NPI: 1598517823
Provider Name (Legal Business Name): KEKELI COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 SOBRO AVE
VALLEY STREAM NY
11580-2323
US

IV. Provider business mailing address

112 SOBRO AVE
VALLEY STREAM NY
11580-2323
US

V. Phone/Fax

Practice location:
  • Phone: 516-491-0485
  • Fax: 516-792-5632
Mailing address:
  • Phone: 516-491-0485
  • Fax: 516-792-5632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. LEONIE ULYSSE
Title or Position: THERAPIST
Credential: LMSW
Phone: 516-491-0485