Provider Demographics
NPI:1790924199
Name:HIGHLANDS PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:HIGHLANDS PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIRKSION
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:973-786-5534
Mailing Address - Street 1:228 ANDOVER SPARTA RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-9759
Mailing Address - Country:US
Mailing Address - Phone:973-786-5534
Mailing Address - Fax:973-579-9007
Practice Address - Street 1:228 ANDOVER SPARTA RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-9759
Practice Address - Country:US
Practice Address - Phone:973-786-5534
Practice Address - Fax:973-579-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00292700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty