Healthcare Provider Details

I. General information

NPI: 1942499017
Provider Name (Legal Business Name): CREATIVE LIVING COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 E ALLENDALE AVE
ALLENDALE NJ
07401-2095
US

IV. Provider business mailing address

172 RIVINGTON ST APT. # 9
NEW YORK NY
10002-2513
US

V. Phone/Fax

Practice location:
  • Phone: 201-327-2424
  • Fax:
Mailing address:
  • Phone: 212-533-0755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. GRETCHEN WHITE JANSSEN
Title or Position: EXECUTIVE DIRECTOR
Credential: DMIN
Phone: 201-327-2424