Healthcare Provider Details

I. General information

NPI: 1881978880
Provider Name (Legal Business Name): COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2011
Last Update Date: 09/22/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 TRUSSUM DRIVE
MAGNOLIA DE
19962
US

IV. Provider business mailing address

P.O. BOX 168
FELTON DE
19943
US

V. Phone/Fax

Practice location:
  • Phone: 845-578-3178
  • Fax: 302-469-5420
Mailing address:
  • Phone: 845-518-3178
  • Fax: 302-469-5420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRO46741-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberRO46741-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberRO46741-1
License Number StateNY

VIII. Authorized Official

Name: MS. MARILYN GREEN
Title or Position: ADMINSITRATOR
Credential: LCSW-R
Phone: 845-473-2175