Healthcare Provider Details

I. General information

NPI: 1497467708
Provider Name (Legal Business Name): A SPACE FOR US COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 04/07/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 W ORMOND AVE STE 100A
CHERRY HILL NJ
08002-3051
US

IV. Provider business mailing address

914 EDGEMOOR RD
CHERRY HILL NJ
08034-3940
US

V. Phone/Fax

Practice location:
  • Phone: 609-920-3848
  • Fax:
Mailing address:
  • Phone: 609-920-3848
  • 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
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEANA REED
Title or Position: OWNER
Credential: MSW, LCSW
Phone: 609-920-3848