Individual
MR. KEVIN MICHAEL WADALAVAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.M.H.C.
Contact information
Practice address
184 BURNS ST, FOREST HILLS, NY 11375-6128
(718) 520-0124
Mailing address
184 BURNS ST, FOREST HILLS, NY 11375-6128
(718) 520-0124
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2421
NY
101YM0800X
Mental Health Counselor
2140
NY
Other
Enumeration date
08/08/2006
Last updated
09/11/2025
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