Healthcare Provider Details

I. General information

NPI: 1063902369
Provider Name (Legal Business Name): LOTUS COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 JEFF ST
EDISON NJ
08837-3029
US

IV. Provider business mailing address

26 JEFF ST
EDISON NJ
08837-3029
US

V. Phone/Fax

Practice location:
  • Phone: 732-742-8597
  • Fax:
Mailing address:
  • Phone: 732-742-8597
  • 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: CHRISTINA LOUISE GUARINO
Title or Position: OWNER
Credential: LPC, NCC
Phone: 732-742-8597