Provider Demographics
NPI:1588013825
Name:STATEWIDE COMMUNITY COUNSELING SERVICES INC
Entity Type:Organization
Organization Name:STATEWIDE COMMUNITY COUNSELING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAINTAMAND
Authorized Official - Suffix:
Authorized Official - Credentials:MHP
Authorized Official - Phone:267-934-7278
Mailing Address - Street 1:4834 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-2606
Mailing Address - Country:US
Mailing Address - Phone:267-934-7278
Mailing Address - Fax:
Practice Address - Street 1:4834 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-2606
Practice Address - Country:US
Practice Address - Phone:267-934-7278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health