Healthcare Provider Details

I. General information

NPI: 1316672413
Provider Name (Legal Business Name): THE COUNSELING CENTER AT MIDDLESEX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 07/21/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 UNION AVE STE 1
MIDDLESEX NJ
08846-1039
US

IV. Provider business mailing address

127 UNION AVE STE 1
MIDDLESEX NJ
08846-1039
US

V. Phone/Fax

Practice location:
  • Phone: 732-893-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN PREMIAN
Title or Position: COUNSELOR
Credential:
Phone: 732-893-2003