Healthcare Provider Details

I. General information

NPI: 1205922200
Provider Name (Legal Business Name): CARLA ANN DENDE MA LCADC LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 MARSHALL STREET
PHILLIPSBURG NJ
08865
US

IV. Provider business mailing address

831 EASTON RD
HELLERTOWN PA
18055
US

V. Phone/Fax

Practice location:
  • Phone: 908-454-4470
  • Fax: 908-454-5317
Mailing address:
  • Phone: 610-967-4982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00118900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: