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General NPI Number Information
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NPI Number | 1184088023
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Entity Type | Organization
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Legal Business Name | TRI-STATE COUNSELING, LLC
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Dates
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Enumeration Date | 04/06/2016
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Last Update Date | 04/06/2016
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Provider Practice Location Address
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Address Line | 45 S PARK PL # 186
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City | MORRISTOWN
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State | NJ
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Zip | 07960-3924
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Country | US
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Telephone | 310-883-4125
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Fax |
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Provider Business Mailing Address
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Address Line | 45 S PARK PL # 186
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City | MORRISTOWN
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State | NJ
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Zip | 07960-3924
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. DEMETRA VAKKAS
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Credential | LPC
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Telephone | 310-883-4125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 37PC00439800
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License Number State | NJ
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