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General NPI Number Information
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NPI Number | 1710726732
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Entity Type | Individual
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Provider Name | DEIJA MCCALLA MHC-LP
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Gender | Female
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 223 BEDFORD AVE STE A
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City | BROOKLYN
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State | NY
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Zip | 11211-3239
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Country | US
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Telephone | 212-287-7979
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Fax |
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Provider Business Mailing Address
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Address Line | 4502 FOSTER AVE
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City | BROOKLYN
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State | NY
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Zip | 11203-5742
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Country | US
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Telephone | 646-248-9699
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | P128036
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License Number State | NY
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