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General NPI Number Information
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NPI Number | 1023470978
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Entity Type | Organization
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Legal Business Name | COUNSELING AND COACHING CENTER
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Dates
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Enumeration Date | 03/21/2016
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Last Update Date | 03/21/2016
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Provider Practice Location Address
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Address Line | 482 BARD AVE FL 3
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City | STATEN ISLAND
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State | NY
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Zip | 10310-2105
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Country | US
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Telephone | 646-764-6562
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Fax |
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Provider Business Mailing Address
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Address Line | 482 BARD AVE FL 3
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City | STATEN ISLAND
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State | NY
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Zip | 10310-2105
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Country | US
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Telephone | 646-764-6562
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | KELLY I GORSKY
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Credential | LMHC, CAMS-I
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Telephone | 646-764-6562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 001590
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License Number State | NY
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