Provider Demographics
NPI:1720637911
Name:PERSONAL LIFE WELLNESS MARRIAGE AND FAMILY THERAPY PLLC
Entity Type:Organization
Organization Name:PERSONAL LIFE WELLNESS MARRIAGE AND FAMILY THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE DIRECTOR/LMFT
Authorized Official - Prefix:
Authorized Official - First Name:SEJGINHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:914-979-6515
Mailing Address - Street 1:42 MEMORIAL PLZ STE 130
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-2943
Mailing Address - Country:US
Mailing Address - Phone:914-979-6515
Mailing Address - Fax:914-614-9321
Practice Address - Street 1:42 MEMORIAL PLZ STE 130
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-2943
Practice Address - Country:US
Practice Address - Phone:914-979-6515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-10
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)