Healthcare Provider Details

I. General information

NPI: 1093856387
Provider Name (Legal Business Name): CUMBERLAND COUNTY GUIDANCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 OPAL RD
MILLVILLE NJ
08332-9754
US

IV. Provider business mailing address

2038 CARMEL RD
MILLVILLE NJ
08332
US

V. Phone/Fax

Practice location:
  • Phone: 856-825-6810
  • Fax: 856-765-0252
Mailing address:
  • Phone: 856-825-6810
  • Fax: 856-765-0252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number26NP04411400
License Number StateNJ

VIII. Authorized Official

Name: MRS. CATHY JEANETTE SOUDERS
Title or Position: OUTPATIENT CASE MANAGER
Credential: LPN
Phone: 856-825-6810