Provider Demographics
NPI:1013658608
Name:DIVERSE SUPPORT COUNSELING, LLC
Entity type:Organization
Organization Name:DIVERSE SUPPORT COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:856-473-5105
Mailing Address - Street 1:3 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08882-1554
Mailing Address - Country:US
Mailing Address - Phone:856-473-5105
Mailing Address - Fax:732-865-7283
Practice Address - Street 1:3 HIGH ST
Practice Address - Street 2:
Practice Address - City:SOUTH RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08882-1554
Practice Address - Country:US
Practice Address - Phone:856-473-5105
Practice Address - Fax:732-865-7283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty