Healthcare Provider Details

I. General information

NPI: 1598972218
Provider Name (Legal Business Name): COUNSELING CENTERS OF DELAWARE VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11000 LINCOLN DR W SUITE 5
MARLTON NJ
08053-3431
US

IV. Provider business mailing address

11000 LINCOLN DR W SUITE 5
MARLTON NJ
08053-3431
US

V. Phone/Fax

Practice location:
  • Phone: 856-985-4300
  • Fax: 856-985-4313
Mailing address:
  • Phone: 856-985-4300
  • Fax: 856-985-4313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JANET COYLE
Title or Position: PRESIDENT
Credential:
Phone: 856-985-4300