Provider Demographics
NPI:1598913931
Name:EASTSIDE COUNSELING SERVICES
Entity Type:Organization
Organization Name:EASTSIDE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:NODO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,CR
Authorized Official - Phone:614-367-1003
Mailing Address - Street 1:1310 HILL RD N
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-7814
Mailing Address - Country:US
Mailing Address - Phone:614-367-1003
Mailing Address - Fax:
Practice Address - Street 1:1310 HILL RD N
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-7814
Practice Address - Country:US
Practice Address - Phone:614-367-1003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH601096-CR101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty