Organization
A DIFFERENT JOURNEY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VIVIAN STANFORD THOMPSON LCSWR (PRIMARY THERAPIST-OWNER)
(646) 263-6227
Entity
Organization
Contact information
Practice address
26 COURT ST STE 1502, BROOKLYN, NY 11242-1115
(646) 263-6227
Mailing address
134 MAIN AVE, LAKE GROVE, NY 11755-2000
(646) 263-6227
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
R059610-1
NY
Other
Enumeration date
04/26/2015
Last updated
04/26/2015
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