Healthcare Provider Details

I. General information

NPI: 1174059364
Provider Name (Legal Business Name): SAFE HARBOR CHRISTIAN COUNSELING OF NEW JERSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2017
Last Update Date: 05/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 WEBRO RD
PARSIPPANY NJ
07054-2831
US

IV. Provider business mailing address

41 BEAVERS ST
HIGH BRIDGE NJ
08829-1720
US

V. Phone/Fax

Practice location:
  • Phone: 410-893-4600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROSEMARY ANN STAPLEY
Title or Position: REGIONAL DIRECTOR
Credential: M.S.
Phone: 410-893-4600