Healthcare Provider Details

I. General information

NPI: 1689183709
Provider Name (Legal Business Name): CUMBERLAND COUNTY GUIDANCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 IRVING AVE
BRIDGETON NJ
08302-2123
US

IV. Provider business mailing address

2038 CARMEL RD
MILLVILLE NJ
08332-9754
US

V. Phone/Fax

Practice location:
  • Phone: 856-455-5555
  • Fax:
Mailing address:
  • Phone: 856-825-6810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: NATALIE DUPNOCK
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 856-825-6810