Provider Demographics
NPI:1003425299
Name:SOUL DISCOVERY MENTAL HEALTH COUNSELING SERVICES PC
Entity Type:Organization
Organization Name:SOUL DISCOVERY MENTAL HEALTH COUNSELING SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOMRELLE-CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-344-0378
Mailing Address - Street 1:333 HEMPSTEAD AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1242
Mailing Address - Country:US
Mailing Address - Phone:347-344-0378
Mailing Address - Fax:
Practice Address - Street 1:333 HEMPSTEAD AVE STE 203
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-1242
Practice Address - Country:US
Practice Address - Phone:347-344-0378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty