Individual
ASSATA THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2090 ADAM CLAYTON POWELL JR BLVD, NEW YORK, NY 10027-4990
(347) 963-7492
Mailing address
590 AVENUES OF AMERICAS, NEW YORK, NY 10011-9904
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
804144973
—
NY
Enumeration date
01/03/2019
Last updated
01/03/2019
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