Provider Demographics
NPI:1790162519
Name:COLLABORTATIVE COUNSELING SERVICERS, LLC
Entity Type:Organization
Organization Name:COLLABORTATIVE COUNSELING SERVICERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE, COLLAB COUN SER, LLC
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARBO
Authorized Official - Suffix:
Authorized Official - Credentials:MA,LPC, NCC, CCDP-D
Authorized Official - Phone:610-340-2626
Mailing Address - Street 1:47 MARCHWOOD RD
Mailing Address - Street 2:SUITE 2A-8
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1835
Mailing Address - Country:US
Mailing Address - Phone:610-340-2626
Mailing Address - Fax:610-340-2626
Practice Address - Street 1:47 MARCHWOOD RD
Practice Address - Street 2:SUITE 2A-8
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1835
Practice Address - Country:US
Practice Address - Phone:610-340-2626
Practice Address - Fax:610-340-2626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty