Healthcare Provider Details

I. General information

NPI: 1366848582
Provider Name (Legal Business Name): CCC COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2014
Last Update Date: 02/26/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 TODD CT
LAKEWOOD NJ
08701-2256
US

IV. Provider business mailing address

1212 TODD CT
LAKEWOOD NJ
08701-2256
US

V. Phone/Fax

Practice location:
  • Phone: 609-225-9355
  • Fax:
Mailing address:
  • Phone: 732-814-4648
  • Fax: 609-228-8896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JEDIEDJAH MOSHE RODRIGUES PEREIRA
Title or Position: OWNER
Credential: MSW, LCSW, LCADC
Phone: 732-814-4648