Healthcare Provider Details

I. General information

NPI: 1063338549
Provider Name (Legal Business Name): CENTERLINE CLINICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 BARBERRY DR
BRICK NJ
08723-4225
US

IV. Provider business mailing address

741 BARBERRY DR
BRICK NJ
08723-4225
US

V. Phone/Fax

Practice location:
  • Phone: 908-675-3496
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANA MILLS
Title or Position: MANAGING MEMBER
Credential: LPC, LCADC
Phone: 908-675-3496