Provider Demographics
NPI:1902491897
Name:ASSOUNGA, KRYSTEL GILBERTE (MHC)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTEL
Middle Name:GILBERTE
Last Name:ASSOUNGA
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8403 LANDER ST APT 3A
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2020
Mailing Address - Country:US
Mailing Address - Phone:201-970-5646
Mailing Address - Fax:
Practice Address - Street 1:20 E 46TH ST RM 1200
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-9246
Practice Address - Country:US
Practice Address - Phone:646-850-2290
Practice Address - Fax:646-850-2295
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP108886101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health