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Organization
LIFE STAGES COUNSELING CENTER, INC
Active
Organization
LIFE STAGES COUNSELING CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TERESA GRELLA HILLEBRAND LMFT (MARRIAGE AND FAMILY THERAPIST)
(516) 617-2635
Entity
Organization
Contact information
Practice address
14 CANDLEWOOD PATH, DIX HILLS, NY 11746-5304
(516) 617-2635
(631) 462-6499
Mailing address
14 CANDLEWOOD PATH, DIX HILLS, NY 11746-5304
(516) 617-2635
(631) 462-6499
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
6464
NY
1041C0700X
Clinical Social Worker
Primary
074243-1
NY
106H00000X
Marriage & Family Therapist
00155-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P3480536
OXFORD PROVIDER ID
NY
Enumeration date
03/20/2007
Last updated
06/05/2008
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