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General NPI Number Information
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NPI Number | 1053535195
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Entity Type | Organization
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Legal Business Name | PASTORAL COUNSELING CENTER OF FLUSHING
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 14210 SANFORD AVE
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City | FLUSHING
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State | NY
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Zip | 11355-2577
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Country | US
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Telephone | 718-463-4613
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Fax |
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Provider Business Mailing Address
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Address Line | 14210 SANFORD AVE
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City | FLUSHING
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State | NY
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Zip | 11355-2577
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Country | US
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Telephone | 718-463-4613
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Fax |
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Authorized Official
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Title or Position | FOUNDER DIRECTOR
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Name | MRS. DERITH ELLEN VAN ETTEN
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Credential | LMHC
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Telephone | 718-463-4613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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