Individual
COLIN KOWLESSAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMHC,CASAC
Contact information
Practice address
17732 129TH AVE, JAMAICA, NY 11434-5822
(718) 300-1018
Mailing address
17732 129TH AVE, JAMAICA, NY 11434-5822
(718) 300-1018
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
23490
NY
101YM0800X
Mental Health Counselor
Primary
007386
NY
Other
Enumeration date
09/30/2016
Last updated
09/30/2016
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