Provider Demographics
NPI:1679158067
Name:RED DOOR THERAPEUTIC COLLECTIVE
Entity Type:Organization
Organization Name:RED DOOR THERAPEUTIC COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TOLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-740-4781
Mailing Address - Street 1:90 STATE STREET
Mailing Address - Street 2:STE 700 OFFICE 40
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207
Mailing Address - Country:US
Mailing Address - Phone:917-740-4781
Mailing Address - Fax:
Practice Address - Street 1:720 LENOX AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-4403
Practice Address - Country:US
Practice Address - Phone:646-996-7826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty