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Organization
WAVE COUNSELING LCSW
Active
Organization
WAVE COUNSELING LCSW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE KELLY WONG (MEMBER-MANAGER)
(845) 202-0634
Entity
Organization
Contact information
Practice address
21 FAIRMONT AVE OFC 28, POUGHKEEPSIE, NY 12603-2409
(845) 202-0634
Mailing address
21 FAIRMONT AVE OFC 28, POUGHKEEPSIE, NY 12603-2409
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
11/13/2024
Last updated
02/13/2025
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