Provider Demographics
NPI:1780377556
Name:NORTHCOUNTRY CLINICAL COUNSELING, LCSW, PLLC
Entity type:Organization
Organization Name:NORTHCOUNTRY CLINICAL COUNSELING, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KILLION
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:315-439-9930
Mailing Address - Street 1:111 KESSLER LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1526
Mailing Address - Country:US
Mailing Address - Phone:315-439-9930
Mailing Address - Fax:
Practice Address - Street 1:5900 N BURDICK ST STE 209
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9463
Practice Address - Country:US
Practice Address - Phone:315-439-9930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-30
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty