Healthcare Provider Details

I. General information

NPI: 1477488930
Provider Name (Legal Business Name): WISHING WELL COMMUNITY CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 HIGHLAND AVE STE C
HADDON TOWNSHIP NJ
08108-2634
US

IV. Provider business mailing address

215 HIGHLAND AVE STE C
HADDON TOWNSHIP NJ
08108-2634
US

V. Phone/Fax

Practice location:
  • Phone: 862-324-4375
  • Fax:
Mailing address:
  • Phone: 862-324-4375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: GARY DOCK SR.
Title or Position: DIRECTOR
Credential: MA, LCADC
Phone: 862-324-4375