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General NPI Number Information
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NPI Number | 1669805602
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Entity Type | Organization
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Legal Business Name | CULTURALLY COMPETENT COMPASSIONATE COUNSELING LCSW PLLC
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Dates
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Enumeration Date | 08/13/2013
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Last Update Date | 08/13/2013
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Provider Practice Location Address
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Address Line | 2504 RICHMOND RD
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City | STATEN ISLAND
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State | NY
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Zip | 10306-2365
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Country | US
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Telephone | 917-613-4009
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Fax | 917-397-9042
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Provider Business Mailing Address
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Address Line | 2504 RICHMOND RD
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City | STATEN ISLAND
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State | NY
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Zip | 10306-2365
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Country | US
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Telephone | 917-613-4009
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Fax | 917-397-9042
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MS. KIMBERLY WILLIAMS-JENKINS
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Credential | LCSW
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Telephone | 917-613-4009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0770581R
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License Number State |
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