MEDICARE: RADIANT AUTHENTIC SOUL THERAPY MENTAL HEALTH COUNSELING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1679425201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIANT AUTHENTIC SOUL THERAPY MENTAL HEALTH COUNSELING PLLC

Provider Business Mailing Address
First Line	:	418 BROADWAY STE R
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12207-2922
Country	:	US
Telephone Number	:	908-445-5193
Fax Number	:

Provider Business Practice Location Address
First Line	:	1270 NEW YORK AVENUE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203
Country	:	US
Telephone Number	:	908-445-5193
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PSYCHOTHERAPIST
Name	:	MS. LADIFATOUN ADISSA SAMBARE
Credential	:	LMHC
Telephone Number	:	908-445-5193

Provider Enumeration Date	:	02/14/2026
Last Update Date	:	03/19/2026

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