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General NPI Number Information
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NPI Number | 1518212935
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Entity Type | Organization
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Legal Business Name | SMC COUNSELING SERVICES
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Dates
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Enumeration Date | 07/23/2012
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Last Update Date | 07/23/2012
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Provider Practice Location Address
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Address Line | 1866 FARGO ST
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City | NORTH BALDWIN
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State | NY
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Zip | 11510-2405
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Country | US
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Telephone | 516-698-5045
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Fax |
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Provider Business Mailing Address
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Address Line | 1866 FARGO ST
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City | NORTH BALDWIN
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State | NY
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Zip | 11510-2405
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Country | US
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Telephone | 516-698-5045
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Fax |
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH COUNSELOR
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Name | MRS. SAMINE CHARLES
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Credential | LMHC
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Telephone | 516-698-5045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 001431-1
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License Number State | NY
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