Individual
MS. ILATISHA IVEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5220 4TH AVE, BROOKLYN, NY 11220-1812
(718) 439-0077
Mailing address
5220 4TH AVE, BROOKLYN, NY 11220-1812
(718) 439-0077
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
10/07/2011
Last updated
10/07/2011
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