Organization
CLUB MENTAL HEALTH COUNSELING SERVICES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LESLIE B MARTIN LMHC (PRESIDENT)
(718) 873-3189
Entity
Organization
Contact information
Practice address
272 ADA DR, STATEN ISLAND, NY 10314-1434
(718) 873-3189
(718) 982-8508
Mailing address
PO BOX 140695, STATEN ISLAND, NY 10314-0695
(781) 873-3189
(718) 982-8508
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
001024-1
NY
Other
Enumeration date
09/23/2010
Last updated
09/23/2010
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