Healthcare Provider Details

I. General information

NPI: 1942139340
Provider Name (Legal Business Name): REBEL HEALER COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 N WOODBURY RD STE 203A
PITMAN NJ
08071-1275
US

IV. Provider business mailing address

199 N WOODBURY RD STE 203A
PITMAN NJ
08071-1275
US

V. Phone/Fax

Practice location:
  • Phone: 856-416-7406
  • Fax: 856-754-5486
Mailing address:
  • Phone: 856-416-7406
  • Fax: 856-754-5486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH NICOLE EALER
Title or Position: OWNER/ THERAPIST
Credential: LPC, LCADC
Phone: 856-649-4013