Healthcare Provider Details

I. General information

NPI: 1184352437
Provider Name (Legal Business Name): AGAPE COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 PENN AVE # 1W
READING PA
19610-2076
US

IV. Provider business mailing address

1161 PENN AVE # 1W
WYOMISSING PA
19610-2076
US

V. Phone/Fax

Practice location:
  • Phone: 484-258-9215
  • Fax:
Mailing address:
  • Phone: 484-258-9215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1659930394
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: DIOSSANTA REYES
Title or Position: OWNER
Credential: LMFT
Phone: 484-258-9215