Healthcare Provider Details

I. General information

NPI: 1083003495
Provider Name (Legal Business Name): SABRINA FAITH BC-DMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2015
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 HADDONFIELD BERLIN RD SUITE 105
GIBBSBORO NJ
08026-1228
US

IV. Provider business mailing address

250 HADDONFIELD BERLIN RD SUITE 105
GIBBSBORO NJ
08026-1228
US

V. Phone/Fax

Practice location:
  • Phone: 856-346-0005
  • Fax: 856-784-1799
Mailing address:
  • Phone: 856-346-0005
  • Fax: 856-784-1799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225600000X
TaxonomyDance Therapist
License NumberBC-DMT-1062
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: