Provider Demographics
NPI:1831532910
Name:COUNSELING SUPPORT SERVICES, LLC
Entity type:Organization
Organization Name:COUNSELING SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TAHARKA
Authorized Official - Middle Name:ABU
Authorized Official - Last Name:SANKARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-337-8323
Mailing Address - Street 1:36 SHREWSBURY DR
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-7619
Mailing Address - Country:US
Mailing Address - Phone:732-272-1340
Mailing Address - Fax:732-272-1390
Practice Address - Street 1:97 APPLE ST STE 3
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-2637
Practice Address - Country:US
Practice Address - Phone:732-337-8323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-09
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05644200261QM0855X, 251S00000X
NJ37LC00174900261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder