Healthcare Provider Details

I. General information

NPI: 1790162519
Provider Name (Legal Business Name): COLLABORTATIVE COUNSELING SERVICERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 MARIAN RD
PHOENIXVILLE PA
19460-2930
US

IV. Provider business mailing address

29 MARIAN RD
PHOENIXVILLE PA
19460-2930
US

V. Phone/Fax

Practice location:
  • Phone: 610-340-2626
  • Fax: 610-340-2626
Mailing address:
  • Phone: 610-340-2626
  • Fax: 610-340-2626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER JAMES CARBO
Title or Position: CO-OWNER, THERAPIST
Credential: MA, LPC, NCC, CAADC
Phone: 484-571-8919