Healthcare Provider Details

I. General information

NPI: 1043175797
Provider Name (Legal Business Name): ELAINES WAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 STOKES RD.
MEDFORD NJ
08055
US

IV. Provider business mailing address

2230 ROUTE 70 W STE 2
CHERRY HILL NJ
08002-3338
US

V. Phone/Fax

Practice location:
  • Phone: 609-346-2485
  • Fax:
Mailing address:
  • Phone: 609-346-2485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANGELA JOHNSON
Title or Position: OWNER
Credential:
Phone: 609-346-2485