Provider Demographics
NPI:1003028549
Name:COMMUNITY COUNSELING AND MEDIATION
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING AND MEDIATION
Other - Org Name:CCMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EMORY
Authorized Official - Middle Name:X
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-802-0666
Mailing Address - Street 1:25 ELM PL FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5355
Mailing Address - Country:US
Mailing Address - Phone:718-802-0666
Mailing Address - Fax:718-858-9493
Practice Address - Street 1:25 ELM PL FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5355
Practice Address - Country:US
Practice Address - Phone:718-802-0666
Practice Address - Fax:718-858-9493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7655100A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health