Healthcare Provider Details

I. General information

NPI: 1760294177
Provider Name (Legal Business Name): FOR THE WELL OF IT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8114 FENWICK CT
LAUREL MD
20707-5612
US

IV. Provider business mailing address

296B MATAWAN AVE
CLIFFWOOD NJ
07721-1240
US

V. Phone/Fax

Practice location:
  • Phone: 732-496-3774
  • Fax:
Mailing address:
  • Phone: 732-496-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: VONDELLE HARRIS
Title or Position: OWNER
Credential:
Phone: 732-496-3774