Provider Demographics
NPI:1669805602
Name:CULTURALLY COMPETENT COMPASSIONATE COUNSELING LCSW PLLC
Entity type:Organization
Organization Name:CULTURALLY COMPETENT COMPASSIONATE COUNSELING LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS-JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-613-4009
Mailing Address - Street 1:2504 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2365
Mailing Address - Country:US
Mailing Address - Phone:917-613-4009
Mailing Address - Fax:917-397-9042
Practice Address - Street 1:2504 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2365
Practice Address - Country:US
Practice Address - Phone:917-613-4009
Practice Address - Fax:917-397-9042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0770581R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty