=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689953739
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MILESTONES MENTAL HEALTH COUNSELING PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2011
-----------------------------------------------------
Last Update Date | 08/08/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 571 EAST NEW YORK AVENUE, OFFICE B
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-663-9027
-----------------------------------------------------
Fax | 347-436-9027
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 571 EAST NEW YORK AVENUE, OFFICE B
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-663-9027
-----------------------------------------------------
Fax | 347-436-9027
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MRS. DEVORAH DAVIDSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 347-663-9027
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------