Healthcare Provider Details

I. General information

NPI: 1023954815
Provider Name (Legal Business Name): ELIZABETH CHAMPION LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 CENTRAL AVE
PORT REPUBLIC NJ
08241-9750
US

IV. Provider business mailing address

147 CENTRAL AVE
PORT REPUBLIC NJ
08241-9750
US

V. Phone/Fax

Practice location:
  • Phone: 609-432-3587
  • Fax:
Mailing address:
  • Phone: 609-432-3587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01255900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: