Healthcare Provider Details

I. General information

NPI: 1912816067
Provider Name (Legal Business Name): REBEKAH WOOLERY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GRAYSON WOOLERY

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MOUNTAIN AVE STE 2-11
HACKETTSTOWN NJ
07840-2397
US

IV. Provider business mailing address

150 MOUNTAIN AVE STE 2-11
HACKETTSTOWN NJ
07840-2397
US

V. Phone/Fax

Practice location:
  • Phone: 908-875-8774
  • Fax:
Mailing address:
  • Phone: 908-948-8355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37AC00995700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: