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General NPI Number Information
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NPI Number | 1417594235
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Entity Type | Organization
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Legal Business Name | INTEGRATED COUNSELING, PLLC
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Dates
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Enumeration Date | 12/01/2019
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Last Update Date | 07/20/2023
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Provider Practice Location Address
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Address Line | 1739 N OCEAN AVE STE A
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City | MEDFORD
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State | NY
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Zip | 11763-2683
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Country | US
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Telephone | 631-747-2106
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Fax |
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Provider Business Mailing Address
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Address Line | 31 NANTUCKET DR
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City | MEDFORD
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State | NY
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Zip | 11763-4346
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Country | US
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Telephone | 631-747-2106
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SEAN WOLL
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Credential | LMHC
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Telephone | 631-747-2106
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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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