Healthcare Provider Details

I. General information

NPI: 1609585645
Provider Name (Legal Business Name): MENDING HEARTS FAMILY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 CATHY LN STE 103
BURLINGTON NJ
08016-9727
US

IV. Provider business mailing address

PO BOX 130
COLUMBUS NJ
08022-0130
US

V. Phone/Fax

Practice location:
  • Phone: 609-499-0165
  • Fax:
Mailing address:
  • Phone: 609-499-0165
  • 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: DANITA SHARICE THOMPSON
Title or Position: CEO/CLINICAL DIRECTOR
Credential: PHD., LMFT
Phone: 609-499-0165