Provider Demographics
NPI:1659522571
Name:DIAGNOSTIC &PROFESSIONAL COUNSELING
Entity Type:Organization
Organization Name:DIAGNOSTIC &PROFESSIONAL COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:COPPADGE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:856-429-1435
Mailing Address - Street 1:145 MANSION AVE
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-1035
Mailing Address - Country:US
Mailing Address - Phone:856-429-1435
Mailing Address - Fax:
Practice Address - Street 1:118 N HADDON AVE
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-2306
Practice Address - Country:US
Practice Address - Phone:856-429-7435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC01492200251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0043494Medicaid