Healthcare Provider Details

I. General information

NPI: 1417634270
Provider Name (Legal Business Name): EMMANUEL COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 KINGS HWY N STE 250
CHERRY HILL NJ
08034-1910
US

IV. Provider business mailing address

1060 KINGS HWY N STE 250
CHERRY HILL NJ
08034-1910
US

V. Phone/Fax

Practice location:
  • Phone: 856-285-5861
  • Fax:
Mailing address:
  • Phone: 856-285-5861
  • Fax: 856-252-0170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: MANOUCHEKA JOHNSON
Title or Position: OWNER
Credential: LCSW
Phone: 856-285-5861