Provider Demographics
NPI:1043897192
Name:CHRISTINE ACKERLY LICENSED MENTAL HEALTH COUNSELOR PC
Entity Type:Organization
Organization Name:CHRISTINE ACKERLY LICENSED MENTAL HEALTH COUNSELOR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ACKERLY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:845-231-2155
Mailing Address - Street 1:25 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-1836
Mailing Address - Country:US
Mailing Address - Phone:845-702-5178
Mailing Address - Fax:
Practice Address - Street 1:1068 MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-3659
Practice Address - Country:US
Practice Address - Phone:845-231-2155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty