Provider Demographics
NPI:1689801219
Name:SPECTRUM COUNSELING SOLUTIONS, LLC
Entity Type:Organization
Organization Name:SPECTRUM COUNSELING SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEIDECKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCADC
Authorized Official - Phone:973-568-1166
Mailing Address - Street 1:248 BROAD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2020
Mailing Address - Country:US
Mailing Address - Phone:973-568-1166
Mailing Address - Fax:732-957-9119
Practice Address - Street 1:248 BROAD ST
Practice Address - Street 2:SUITE B
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2020
Practice Address - Country:US
Practice Address - Phone:973-568-1166
Practice Address - Fax:732-957-9119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00057200101YA0400X
NJ37PC00020000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty