Healthcare Provider Details

I. General information

NPI: 1578003075
Provider Name (Legal Business Name): FALCON COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CROZIER AVE
NATIONAL PARK NJ
08063-1512
US

IV. Provider business mailing address

500 CROZIER AVE
NATIONAL PARK NJ
08063-1512
US

V. Phone/Fax

Practice location:
  • Phone: 856-693-4192
  • Fax:
Mailing address:
  • Phone: 856-693-4192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number44SC05627200
License Number StateNJ

VIII. Authorized Official

Name: SUSANNAH MALLON
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 856-693-4192