Provider Demographics
NPI:1659591915
Name:PROFESSIONAL COUNSELING SERVICES OF PRINCETON LLC
Entity Type:Organization
Organization Name:PROFESSIONAL COUNSELING SERVICES OF PRINCETON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:HICKOK
Authorized Official - Suffix:SR
Authorized Official - Credentials:LPC
Authorized Official - Phone:609-529-7526
Mailing Address - Street 1:1 HIGHGATE DR
Mailing Address - Street 2:APT #410
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-2030
Mailing Address - Country:US
Mailing Address - Phone:609-529-7526
Mailing Address - Fax:
Practice Address - Street 1:863 STATE RD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540
Practice Address - Country:US
Practice Address - Phone:609-529-7526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00100200251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherEIN