Healthcare Provider Details

I. General information

NPI: 1679303317
Provider Name (Legal Business Name): FAMILY & COMMUNITY GROWTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 GLENWOOD AVE
BURLINGTON NJ
08016-2512
US

IV. Provider business mailing address

269 CLAFLIN AVE
EWING NJ
08638-2356
US

V. Phone/Fax

Practice location:
  • Phone: 609-807-8304
  • Fax:
Mailing address:
  • Phone: 609-807-8304
  • 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 Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: KATIE ONITIRI
Title or Position: CO-OWNER
Credential: LMFT, LCADC
Phone: 609-807-8304