Healthcare Provider Details

I. General information

NPI: 1548507890
Provider Name (Legal Business Name): CENTER FOR HEALING BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 10/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 SCOTCH RD STE B
EWING NJ
08628-2529
US

IV. Provider business mailing address

PO BOX 9899
TRENTON NJ
08650-1899
US

V. Phone/Fax

Practice location:
  • Phone: 609-583-4915
  • Fax: 609-613-5571
Mailing address:
  • Phone: 609-583-4915
  • Fax: 609-613-5571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2000472
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number2000500
License Number StateNJ

VIII. Authorized Official

Name: MRS. ERICA FRANCO MORTIMER
Title or Position: CEO/CLINICAL DIRECTOR
Credential: LCADC, LAC
Phone: 609-583-4915