| Tidewater Mental Health Counseling Pllc | |
|
172 W 21st St Huntington Station NY 11746-2122 | |
| (484) 599-1580 | |
| Not Available |
| Full Name | Tidewater Mental Health Counseling Pllc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 172 W 21st St, Huntington Station, New York |
| Authorized Official Name and Position | Jacquelyn Jackson (OWNER) |
| Authorized Official Contact | 4845991580 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tidewater Mental Health Counseling Pllc 172 W 21st St Huntington Station NY 11746-2122 Ph: (484) 599-1580 | Tidewater Mental Health Counseling Pllc 172 W 21st St Huntington Station NY 11746-2122 Ph: (484) 599-1580 |
| NPI Number | 1497556088 |
|---|---|
| Provider Enumeration Date | 03/20/2025 |
| Last Update Date | 03/20/2025 |
| Certification Date | 03/20/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497556088 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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