Provider Demographics
NPI:1437316338
Name:NORTHEAST COUNSELING SERVICES
Entity Type:Organization
Organization Name:NORTHEAST COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDO
Authorized Official - Suffix:JR
Authorized Official - Credentials:LSW
Authorized Official - Phone:570-735-7590
Mailing Address - Street 1:130 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634-3113
Mailing Address - Country:US
Mailing Address - Phone:570-735-7590
Mailing Address - Fax:
Practice Address - Street 1:24 E BROAD ST
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634-2307
Practice Address - Country:US
Practice Address - Phone:570-735-6004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1007615710027261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007615710027Medicaid