Provider Demographics
NPI:1982118659
Name:EMMANUEL COUNSELING SERVICE
Entity Type:Organization
Organization Name:EMMANUEL COUNSELING SERVICE
Other - Org Name:EMMANUEL COUNSELING SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAMAR
Authorized Official - Middle Name:TYRE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:NMD
Authorized Official - Phone:845-309-0037
Mailing Address - Street 1:548 THROGGS NECK EXPY
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1717
Mailing Address - Country:US
Mailing Address - Phone:845-309-0037
Mailing Address - Fax:845-486-9801
Practice Address - Street 1:548 THROGGS NECK EXPY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1717
Practice Address - Country:US
Practice Address - Phone:845-309-0037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-16
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty