Provider Demographics
NPI:1295259893
Name:PEACEFUL LIVING COUNSELING & PROFESSIONAL SERVICES, INC.
Entity type:Organization
Organization Name:PEACEFUL LIVING COUNSELING & PROFESSIONAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:
Authorized Official - Last Name:LSW, ACSW, CAMS-II, CGT
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:267-343-5327
Mailing Address - Street 1:2417 WELSH RD STE 223
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2211
Mailing Address - Country:US
Mailing Address - Phone:267-343-5327
Mailing Address - Fax:267-343-5861
Practice Address - Street 1:2417 WELSH RD STE 223
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2211
Practice Address - Country:US
Practice Address - Phone:267-343-5327
Practice Address - Fax:267-343-8177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-26
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000OtherN/A