Provider Demographics
NPI:1649803867
Name:WAY STATION COUNSELING, LLC
Entity type:Organization
Organization Name:WAY STATION COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEJESUS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:215-313-3689
Mailing Address - Street 1:128 FRANCES MEEKS WAY STE 6
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-3984
Mailing Address - Country:US
Mailing Address - Phone:912-999-3888
Mailing Address - Fax:
Practice Address - Street 1:128 FRANCES MEEKS WAY STE 6
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3984
Practice Address - Country:US
Practice Address - Phone:912-999-3888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty