Healthcare Provider Details

I. General information

NPI: 1922498575
Provider Name (Legal Business Name): GREATER TRENTON COMMUNITY MENTAL HEALTH CERNTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 BRUNSWICK PIKE
LAWRENCEVILLE NJ
08648-4103
US

IV. Provider business mailing address

2550 BRUNSWICK PIKE
LAWRENCEVILLE NJ
08648-4103
US

V. Phone/Fax

Practice location:
  • Phone: 609-396-8877
  • Fax:
Mailing address:
  • Phone: 609-396-8877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: DONTAY CHESTER WILLIAMS
Title or Position: COUNSELOR
Credential: LAC
Phone: 267-210-6590