Provider Demographics
NPI:1831821289
Name:WELLNESS COUNSELING SERVICES, LCSW, PLLC
Entity type:Organization
Organization Name:WELLNESS COUNSELING SERVICES, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DUCOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R, CASAC-MASTER
Authorized Official - Phone:347-620-3339
Mailing Address - Street 1:2294 E 15TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4640
Mailing Address - Country:US
Mailing Address - Phone:347-620-3339
Mailing Address - Fax:
Practice Address - Street 1:2294 E 15TH ST APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4640
Practice Address - Country:US
Practice Address - Phone:347-620-3339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-25
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)