Healthcare Provider Details

I. General information

NPI: 1083276836
Provider Name (Legal Business Name): HOPEFULL THERAPY AND CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 WITHERSPOON ST STE A4
PRINCETON NJ
08542-3228
US

IV. Provider business mailing address

72 GROVELAND AVE
EWING NJ
08638-2867
US

V. Phone/Fax

Practice location:
  • Phone: 609-791-9579
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAMARA JACKSON
Title or Position: OWER
Credential: LCSW, MDIV
Phone: 609-216-1786