Individual
MS. KIM LESLIE-UNDERWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MHC-LP, CASAC-2
Contact information
Practice address
804 E 138TH ST, BRONX, NY 10454-1932
(609) 942-9479
Mailing address
804 E 138TH ST, BRONX, NY 10454-1932
(609) 942-9479
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
13055
NY
101YM0800X
Mental Health Counselor
P106105
NY
Other
Enumeration date
01/07/2021
Last updated
04/17/2025
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