Provider Demographics
NPI:1285965517
Name:AIRMID COUNSELING SERVICES
Entity type:Organization
Organization Name:AIRMID COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER/ CLINICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARAKA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCADC
Authorized Official - Phone:973-678-0550
Mailing Address - Street 1:137 EVERGREEN PL
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2005
Mailing Address - Country:US
Mailing Address - Phone:973-678-0550
Mailing Address - Fax:973-678-1177
Practice Address - Street 1:137 EVERGREEN PL
Practice Address - Street 2:SUITE 2D
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2005
Practice Address - Country:US
Practice Address - Phone:973-678-0550
Practice Address - Fax:973-678-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health