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Organization
STILL WATERS LCSW PLLC
Active
Organization
STILL WATERS LCSW PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THERON DE-WITT ISON LCSW (CEO)
(347) 564-3552
Entity
Organization
Contact information
Practice address
16005 76TH AVE APT 1B, FLUSHING, NY 11366-1108
(347) 564-3552
Mailing address
16005 76TH AVE APT 1B, FLUSHING, NY 11366-1108
(347) 564-3552
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
04/14/2025
Last updated
04/14/2025
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