Provider Demographics
NPI:1336634021
Name:CONCORD COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:CONCORD COUNSELING SERVICES LLC
Other - Org Name:CONCORD COUNSELING SERVICES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:609-351-5088
Mailing Address - Street 1:816 W ROUTE 130
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-1267
Mailing Address - Country:US
Mailing Address - Phone:609-668-2795
Mailing Address - Fax:
Practice Address - Street 1:816 W ROUTE 130
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-1267
Practice Address - Country:US
Practice Address - Phone:609-668-2795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty