Provider Demographics
NPI:1114636842
Name:POSITIVE IMPACT COUNSELING
Entity Type:Organization
Organization Name:POSITIVE IMPACT COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-664-4594
Mailing Address - Street 1:1903 BRECKENRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-0900
Mailing Address - Country:US
Mailing Address - Phone:732-664-4594
Mailing Address - Fax:
Practice Address - Street 1:1903 BRECKENRIDGE PL
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-0900
Practice Address - Country:US
Practice Address - Phone:732-664-4594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health