Provider Demographics
NPI:1083998934
Name:VISION COUNSELING SERVICES,LLC
Entity Type:Organization
Organization Name:VISION COUNSELING SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CLARENCE
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MHS,LPC,CADC,LCADC
Authorized Official - Phone:570-426-0096
Mailing Address - Street 1:1843 ROUTE 209
Mailing Address - Street 2:SOUTH SAFEWAY COMPLEX SUITE 1
Mailing Address - City:BRODHEADSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18322-0826
Mailing Address - Country:US
Mailing Address - Phone:570-426-0096
Mailing Address - Fax:
Practice Address - Street 1:1843 ROUTE 209
Practice Address - Street 2:SAFEWAY STORAGE COMPLEX
Practice Address - City:BRODHEADSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18322-7134
Practice Address - Country:US
Practice Address - Phone:570-801-7373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-10
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005541103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty