Healthcare Provider Details

I. General information

NPI: 1457915241
Provider Name (Legal Business Name): EXCELSIOR COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 MIDVALE RD STE 1F
MOUNTAIN LAKES NJ
07046-1330
US

IV. Provider business mailing address

36 MIDVALE RD STE 1F
MOUNTAIN LAKES NJ
07046-1330
US

V. Phone/Fax

Practice location:
  • Phone: 973-902-9925
  • Fax:
Mailing address:
  • Phone: 973-902-9925
  • Fax:

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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER LANGFORD
Title or Position: MANAGING PARTNER
Credential: LPC
Phone: 973-563-5688