Provider Demographics
NPI:1205688181
Name:LIONHEART PSYCHOTHERAPY MENTAL HEALTH COUNSELING PLLC
Entity type:Organization
Organization Name:LIONHEART PSYCHOTHERAPY MENTAL HEALTH COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ADALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:858-964-8329
Mailing Address - Street 1:238 WARREN ST APT E
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-2154
Mailing Address - Country:US
Mailing Address - Phone:858-964-8329
Mailing Address - Fax:
Practice Address - Street 1:238 WARREN ST APT E
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-2154
Practice Address - Country:US
Practice Address - Phone:858-964-8329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty