Healthcare Provider Details

I. General information

NPI: 1548850423
Provider Name (Legal Business Name): CHRISLYN ELISE ECHOLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W HAWTHORNE AVE
VALLEY STREAM NY
11580-6223
US

IV. Provider business mailing address

30 3RD AVE APT 5A
BROOKLYN NY
11217-2383
US

V. Phone/Fax

Practice location:
  • Phone: 516-569-6600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: