Provider Demographics
NPI:1669483350
Name:SENIOR IN-HOME COUNSELING LLC
Entity Type:Organization
Organization Name:SENIOR IN-HOME COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:0WNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-793-2846
Mailing Address - Street 1:3405 FONTANA LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-0109
Mailing Address - Country:US
Mailing Address - Phone:631-793-2846
Mailing Address - Fax:
Practice Address - Street 1:3405 FONTANA LAKE DR
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-0109
Practice Address - Country:US
Practice Address - Phone:631-793-2846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07013311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1235131566OtherINDIV NPI
NY02168298Medicaid
NY02168298Medicaid
NY1235131566OtherINDIV NPI