Provider Demographics
NPI:1376088096
Name:PEACE-FILLED MENTAL HEALTH COUNSELING SERVICES
Entity Type:Organization
Organization Name:PEACE-FILLED MENTAL HEALTH COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:JEANNINE
Authorized Official - Last Name:SANDO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:718-869-1054
Mailing Address - Street 1:26 COURT ST
Mailing Address - Street 2:SUITE 1210
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11242-0103
Mailing Address - Country:US
Mailing Address - Phone:718-869-1054
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST
Practice Address - Street 2:SUITE 1210
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-0103
Practice Address - Country:US
Practice Address - Phone:718-869-1054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004410-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty