Provider Demographics
NPI:1275049884
Name:JUST 4 YOU FAMILY SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:JUST 4 YOU FAMILY SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:MR
Authorized Official - First Name:KENRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFRED
Authorized Official - Suffix:
Authorized Official - Credentials:CASAC-T, CAMS II
Authorized Official - Phone:631-575-8062
Mailing Address - Street 1:608 JOHNSON AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-2690
Mailing Address - Country:US
Mailing Address - Phone:631-575-8062
Mailing Address - Fax:631-761-9475
Practice Address - Street 1:608 JOHNSON AVE STE 2
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-2690
Practice Address - Country:US
Practice Address - Phone:631-575-8062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty