Provider Demographics
NPI:1790519122
Name:VITALITY COUNSELING LCSW PC
Entity type:Organization
Organization Name:VITALITY COUNSELING LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:THALHAMER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-834-8647
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-0188
Mailing Address - Country:US
Mailing Address - Phone:631-834-8647
Mailing Address - Fax:
Practice Address - Street 1:11 THAYER PL
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4331
Practice Address - Country:US
Practice Address - Phone:631-834-8647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty