Healthcare Provider Details

I. General information

NPI: 1578843660
Provider Name (Legal Business Name): SOLSTICE COUNSELING SERVICES CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BIRMINGHAM RD
PEMBERTON NJ
08068-1326
US

IV. Provider business mailing address

300 BIRMINGHAM RD
PEMBERTON NJ
08068-1326
US

V. Phone/Fax

Practice location:
  • Phone: 609-288-8844
  • Fax: 609-288-7210
Mailing address:
  • Phone: 609-288-8844
  • Fax: 609-288-7210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number2000499-11
License Number StateNJ

VIII. Authorized Official

Name: MICHAEL MANDALE
Title or Position: CEO
Credential: JD
Phone: 609-288-8844