Healthcare Provider Details

I. General information

NPI: 1184862443
Provider Name (Legal Business Name): TIMOTHY FAITH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2009
Last Update Date: 01/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 STONEHAM DR
GLASSBORO NJ
08028-3001
US

IV. Provider business mailing address

101 STONEHAM DR
GLASSBORO NJ
08028-3001
US

V. Phone/Fax

Practice location:
  • Phone: 609-970-4680
  • Fax:
Mailing address:
  • Phone: 609-970-4680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number37PC00250000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number37PC00250000
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00250000
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number37PC00250000
License Number StateNJ

VIII. Authorized Official

Name: MS. PAMELA MAE NIELSEN
Title or Position: DIRECTOR
Credential: LPC, NCC, MC
Phone: 609-970-4680