Healthcare Provider Details

I. General information

NPI: 1679263875
Provider Name (Legal Business Name): DCS SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 05/10/2023
Certification Date: 04/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 HUDSON AVE
NORTH PLAINFIELD NJ
07060
US

IV. Provider business mailing address

1515 ROUTE 22 W STE 30
WATCHUNG NJ
07069-6516
US

V. Phone/Fax

Practice location:
  • Phone: 732-395-9323
  • Fax: 908-547-0055
Mailing address:
  • Phone: 732-395-9323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DETRIA COLES-SIMMONS
Title or Position: OPERATOR
Credential: LPC
Phone: 732-395-9323