=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184849457
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POSITIVE PERCEPTIONS COUNSELING AND SUPPORT SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2007
-----------------------------------------------------
Last Update Date | 03/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 529 SEVEN BRIDGE RD UNIT 105
-----------------------------------------------------
City | EAST STROUDSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18301-7608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-424-1768
-----------------------------------------------------
Fax | 888-314-5032
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 387 LAKE RD
-----------------------------------------------------
City | TOBYHANNA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18466-8038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-839-4011
-----------------------------------------------------
Fax | 888-862-7310
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED CLINICAL SOCIAL WORKER
-----------------------------------------------------
Name | NICHELLE RENEE JONES
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 570-839-4011
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CW015018
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------