MEDICARE: LDK COUNSELING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	37PC00310900	NJ

General Provider Information

NPI Number	:	1609035401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LDK COUNSELING, LLC

Provider Business Mailing Address
First Line	:	786 MOUNTAIN BLVD
Second Line	:	SUITE 102
City	:	WATCHUNG
State	:	NJ
Zip	:	07069-6268
Country	:	US
Telephone Number	:	908-755-3055
Fax Number	:	908-755-3155

Provider Business Practice Location Address
First Line	:	786 MOUNTAIN BLVD
Second Line	:	SUITE 102
City	:	WATCHUNG
State	:	NJ
Zip	:	07069-6268
Country	:	US
Telephone Number	:	908-755-3055
Fax Number	:	908-755-3155

Authorized Official
Title or Position	:	OWNER
Name	:	LESLIE GAYLE KUBISIAK
Credential	:	MA, LPC, NCC
Telephone Number	:	908-755-3055

Provider Enumeration Date	:	06/06/2008
Last Update Date	:	06/06/2008

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