Healthcare Provider Details

I. General information

NPI: 1316205560
Provider Name (Legal Business Name): GINA M PECCIA, MA, LPC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 NEW RD STE 12B
LINWOOD NJ
08221-1045
US

IV. Provider business mailing address

2021 NEW RD STE 12B
LINWOOD NJ
08221-1045
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 609-204-9940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00361000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. GINA MARIE PECCIA
Title or Position: OWNER
Credential: LPC
Phone: 609-204-9940