Provider Demographics
NPI:1619707650
Name:COMMUNITY COUNSELING TOO LCSW SERVICES PLLC
Entity type:Organization
Organization Name:COMMUNITY COUNSELING TOO LCSW SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXCUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWR
Authorized Official - Phone:631-294-0216
Mailing Address - Street 1:468 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MASTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11951-3407
Mailing Address - Country:US
Mailing Address - Phone:631-300-7910
Mailing Address - Fax:631-772-6221
Practice Address - Street 1:468 MAIN ST
Practice Address - Street 2:
Practice Address - City:MASTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11951-3407
Practice Address - Country:US
Practice Address - Phone:631-294-0216
Practice Address - Fax:631-772-6221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty