Individual
CARLA JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
10326 68TH RD, FOREST HILLS, NY 11375-3200
(718) 261-3330
Mailing address
14021 COOMBS ST, SPRINGFIELD GARDENS, NY 11413-2675
(929) 385-6765
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
010630
NY
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
634459630
NYS ID
NY
Enumeration date
08/12/2015
Last updated
01/31/2025
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