Healthcare Provider Details

I. General information

NPI: 1902585482
Provider Name (Legal Business Name): IN SOLIDARITY COUNSELING PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 10/16/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 HAWTHORNE AVE
EWING NJ
08638-2823
US

IV. Provider business mailing address

17 HAWTHORNE AVE
EWING NJ
08638-2823
US

V. Phone/Fax

Practice location:
  • Phone: 609-672-6668
  • Fax:
Mailing address:
  • Phone: 609-672-6668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. MARCIA K MACKILLOP
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 609-672-6668