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General NPI Number Information
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NPI Number | 1215211669
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Entity Type | Organization
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Legal Business Name | INDEPENDENCE COUNSELING CENTER
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Dates
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Enumeration Date | 10/04/2011
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Last Update Date | 10/04/2011
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Provider Practice Location Address
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Address Line | 10 FISKE PL 205
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City | MOUNT VERNON
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State | NY
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Zip | 10550-3205
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Country | US
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Telephone | 914-664-0400
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Fax | 914-664-0404
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Provider Business Mailing Address
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Address Line | 10 FISKE PL 205
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City | MOUNT VERNON
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State | NY
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Zip | 10550-3205
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Country | US
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Telephone | 914-664-0400
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Fax | 914-664-0404
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. KAREN GREEN POLLARD
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Credential | MSW
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Telephone | 914-664-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6383705
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License Number State | NY
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