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General NPI Number Information
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NPI Number | 1215747522
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Entity Type | Organization
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Legal Business Name | NEW WINGS MENTAL HEALTH COUNSELING, P.C.
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 11 MADISON BLVD STE 17
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City | CANASTOTA
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State | NY
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Zip | 13032-3508
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Country | US
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Telephone | 315-630-8314
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Fax | 315-907-6156
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Provider Business Mailing Address
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Address Line | 112 CAROLINE ST
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City | CANASTOTA
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State | NY
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Zip | 13032-1205
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Country | US
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Telephone | 315-630-8314
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Fax | 316-907-6156
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Authorized Official
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Title or Position | PRESIDENT
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Name | JENNIFER LYNN AYER
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Credential | LMHC
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Telephone | 315-630-8314
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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 |
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License Number State |
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