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Organization

AMBITIOUS SOULE L.L.C

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DOMINIQUE PARKER (CASAC-T)
(929) 393-8273
Entity
Organization

Contact information

Practice address
10725 FERN PL, JAMAICA, NY 11433-2598
(201) 357-7181
Mailing address
288 PARK AVE S PMB 153925, NEW YORK, NY 10003

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary

Other

Enumeration date
03/23/2026
Last updated
03/23/2026
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