Healthcare Provider Details

I. General information

NPI: 1235657669
Provider Name (Legal Business Name): JMR WELLNESS AND COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 RIDGE RD
NORTH ARLINGTON NJ
07031-6359
US

IV. Provider business mailing address

89 RIDGE RD
NORTH ARLINGTON NJ
07031-6359
US

V. Phone/Fax

Practice location:
  • Phone: 848-250-3638
  • Fax:
Mailing address:
  • Phone: 848-250-3638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00235200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00519300
License Number StateNJ

VIII. Authorized Official

Name: MR. JOSE M RODRIGUEZ
Title or Position: OWNER
Credential: LPC
Phone: 848-250-3638