Healthcare Provider Details

I. General information

NPI: 1821661653
Provider Name (Legal Business Name): RIVER IN EDEN COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 HADDONFIELD RD # 764
CHERRY HILL NJ
08002-2775
US

IV. Provider business mailing address

926 HADDONFIELD RD # 764
CHERRY HILL NJ
08002-2775
US

V. Phone/Fax

Practice location:
  • Phone: 609-447-1280
  • Fax:
Mailing address:
  • Phone: 609-447-1280
  • 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 Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHONDA BROOKS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 609-447-1280