Healthcare Provider Details

I. General information

NPI: 1861244709
Provider Name (Legal Business Name): CHAIRVILLE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CHAIRVILLE RD
MEDFORD NJ
08055-9619
US

IV. Provider business mailing address

11 CHAIRVILLE RD
MEDFORD NJ
08055-9619
US

V. Phone/Fax

Practice location:
  • Phone: 609-388-8919
  • Fax:
Mailing address:
  • Phone: 609-975-9769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER AGNES GOULD
Title or Position: MANAGING DIRECTOR
Credential: MA, LPC, NCC
Phone: 609-975-3250