Provider Demographics
NPI:1184849457
Name:POSITIVE PERCEPTIONS COUNSELING AND SUPPORT SERVICES, INC
Entity Type:Organization
Organization Name:POSITIVE PERCEPTIONS COUNSELING AND SUPPORT SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:NICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:570-839-4011
Mailing Address - Street 1:387 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:TOBYHANNA
Mailing Address - State:PA
Mailing Address - Zip Code:18466-8038
Mailing Address - Country:US
Mailing Address - Phone:570-839-4011
Mailing Address - Fax:888-862-7310
Practice Address - Street 1:529 SEVEN BRIDGE RD UNIT 105
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-7608
Practice Address - Country:US
Practice Address - Phone:570-424-1768
Practice Address - Fax:888-314-5032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2023-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
PACW0150181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031161560002Medicaid
PA101401517 0003Medicaid