Provider Demographics
NPI:1073941126
Name:SUPPORTIVE COUNSELING SERVICES
Entity Type:Organization
Organization Name:SUPPORTIVE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CORLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:HULLFISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-410-8607
Mailing Address - Street 1:53 S MAIN ST
Mailing Address - Street 2:SUITE 3F
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-2442
Mailing Address - Country:US
Mailing Address - Phone:609-410-8607
Mailing Address - Fax:609-257-0680
Practice Address - Street 1:53 S MAIN ST
Practice Address - Street 2:SUITE 3F
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2442
Practice Address - Country:US
Practice Address - Phone:609-410-8607
Practice Address - Fax:609-257-0680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052496001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty