Tidewater Mental Health Counseling Pllc
NPI #1497556088 in Huntington Station, New York
Provider Information
- NPI Number
- 1497556088
- Entity Type
- Organization
- Organization Name
- Tidewater Mental Health Counseling Pllc
- Primary Specialty
- Clinic/Center - Mental Health (Including Community Mental Health Center)
- Enumeration Date
- Mar 20, 2025
- Last Updated
- Mar 20, 2025
Practice Location
- Address
- 172 W 21ST ST
- State
- New York
- ZIP Code
- 11746-2122
- Phone
- (484) 599-1580
Authorized Official
- Name
- JACQUELYN JACKSON, LMHC-D
- Title
- OWNER
- Phone
- (484) 599-1580
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center) |
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