Healthcare Provider Details

I. General information

NPI: 1871813469
Provider Name (Legal Business Name): COUNSELING CENTER AT HAMILTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 06/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2667 NOTTINGHAM WAY STE 3
HAMILTON NJ
08619-4116
US

IV. Provider business mailing address

2667 NOTTINGHAM WAY STE 3
HAMILTON NJ
08619-4116
US

V. Phone/Fax

Practice location:
  • Phone: 609-890-9998
  • Fax: 609-890-9998
Mailing address:
  • Phone: 609-890-9998
  • Fax: 609-890-9998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00017900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00289900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW-011397-L
License Number StatePA

VIII. Authorized Official

Name: MRS. JOANNA O'NEILL
Title or Position: DIRECTOR/ THERAPIST
Credential: MA. LPC. NCC.
Phone: 609-890-9998