Healthcare Provider Details

I. General information

NPI: 1013493469
Provider Name (Legal Business Name): STEPHANIE RITA MCCOLL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JEWISH FAMILY SERVICE 607 N. JEROME AVE
MARGATE CITY NJ
08402
US

IV. Provider business mailing address

1 HAWTHORNE DR
TINTON FALLS NJ
07753-7596
US

V. Phone/Fax

Practice location:
  • Phone: 609-822-1108
  • Fax: 609-822-1106
Mailing address:
  • Phone: 609-822-1108
  • Fax: 609-822-1106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00634300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: