Provider Demographics
NPI:1891575650
Name:AMMONITE COUNSELING LCSW
Entity Type:Organization
Organization Name:AMMONITE COUNSELING LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SZACIK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-915-5714
Mailing Address - Street 1:43 WESTSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-2025
Mailing Address - Country:US
Mailing Address - Phone:541-915-5714
Mailing Address - Fax:
Practice Address - Street 1:258 USHERS RD STE 203
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-1428
Practice Address - Country:US
Practice Address - Phone:588-861-3330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health