Provider Demographics
NPI:1700570025
Name:SUPPORTIVE SOULS COUNSELING
Entity Type:Organization
Organization Name:SUPPORTIVE SOULS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRESCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-829-9690
Mailing Address - Street 1:81 SHARON AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-4516
Mailing Address - Country:US
Mailing Address - Phone:732-829-9690
Mailing Address - Fax:
Practice Address - Street 1:81 SHARON AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-4516
Practice Address - Country:US
Practice Address - Phone:732-829-9690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty