Healthcare Provider Details

I. General information

NPI: 1013687953
Provider Name (Legal Business Name): A JOURNEY WALKED TOGETHER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 STATE ROUTE 33 STE 211
NEPTUNE CITY NJ
07753-6122
US

IV. Provider business mailing address

2240 STATE ROUTE 33 STE 211
NEPTUNE CITY NJ
07753-6122
US

V. Phone/Fax

Practice location:
  • Phone: 732-819-1505
  • Fax: 732-655-6160
Mailing address:
  • Phone: 732-819-1505
  • Fax: 732-655-6160

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 Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ELAINE ANNE YOUNG
Title or Position: PRESIDENT
Credential:
Phone: 732-819-1505