Healthcare Provider Details

I. General information

NPI: 1134761372
Provider Name (Legal Business Name): COUNSELING FOR WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 BROAD ST STE 2
CLIFTON NJ
07013-1643
US

IV. Provider business mailing address

32 LENNON PL
CLIFTON NJ
07013-3325
US

V. Phone/Fax

Practice location:
  • Phone: 973-207-5043
  • Fax:
Mailing address:
  • Phone: 973-207-5043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARLOS HERNANDEZ
Title or Position: THERAPIST
Credential: MED,LPC
Phone: 973-207-5043