=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265983241
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DC COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2016
-----------------------------------------------------
Last Update Date | 10/14/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 147 COLUMBIA TPKE SUITE 307
-----------------------------------------------------
City | FLORHAM PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07932-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-654-0699
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 147 COLUMBIA TPKE SUITE 307
-----------------------------------------------------
City | FLORHAM PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07932-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-654-0699
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MISS DIANA LORENA CERON
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 201-654-0699
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 37PC00473200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------