Provider Demographics
NPI:1356518666
Name:NORTHEAST COUNSELING SERVICES
Entity type:Organization
Organization Name:NORTHEAST COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDO
Authorized Official - Suffix:JR
Authorized Official - Credentials:LSW
Authorized Official - Phone:5707-357-5090
Mailing Address - Street 1:130 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634-3113
Mailing Address - Country:US
Mailing Address - Phone:570-735-7590
Mailing Address - Fax:
Practice Address - Street 1:120 E 3RD ST # R
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-3726
Practice Address - Country:US
Practice Address - Phone:570-759-7855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA100761571261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100761571Medicaid
PA1007615710044Medicaid