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General NPI Number Information
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NPI Number | 1134656564
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Entity Type | Organization
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Legal Business Name | HIGHER LIFE PATHWAYS MENTAL HEALTH COUNSELING LLC
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Dates
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Enumeration Date | 05/16/2017
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Last Update Date | 05/16/2017
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Provider Practice Location Address
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Address Line | 6143 186TH ST
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City | FRESH MEADOWS
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State | NY
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Zip | 11365-2710
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Country | US
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Telephone | 516-268-0064
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 280735
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City | QUEENS VILLAGE
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State | NY
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Zip | 11428-0735
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Country | US
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Telephone | 516-268-0064
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. DINELLY HOLDER
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Credential | PHD, NCC, CCMHC
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Telephone | 516-268-0064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00459100
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License Number State | NJ
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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 | 005132
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License Number State | NY
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