Healthcare Provider Details

I. General information

NPI: 1679161079
Provider Name (Legal Business Name): TRACE INSTITUTE OF COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2021
Last Update Date: 01/02/2021
Certification Date: 01/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 EVANS PLACE SECOND FLR. SUITE 2
POMPTON PLAINS NJ
07444
US

IV. Provider business mailing address

531 CHERRY ST APT C7
ELIZABETH NJ
07208-1878
US

V. Phone/Fax

Practice location:
  • Phone: 973-400-9702
  • Fax:
Mailing address:
  • Phone: 908-468-4683
  • Fax: 866-656-1205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282J00000X
TaxonomyReligious Nonmedical Health Care Institution
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM HAMPTON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 908-468-4683