=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629937610
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIDAS COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2026
-----------------------------------------------------
Last Update Date | 01/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 N BEECH RD
-----------------------------------------------------
City | WILKES BARRE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18705-2201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-932-8523
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 N BEECH RD
-----------------------------------------------------
City | WILKES BARRE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18705-2201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-932-8523
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | YVETTE PERDOMO
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 973-932-8523
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------