Individual
AMUDALAT FOLA LASISI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
1045 JAMES ST, SYRACUSE, NY 13203-2730
(315) 472-4471
(315) 472-1759
Mailing address
14450 177TH ST, JAMAICA, NY 11434-4918
(347) 869-7660
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
008259
NY
Other
Enumeration date
09/30/2016
Last updated
01/12/2018
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