Healthcare Provider Details

I. General information

NPI: 1952169740
Provider Name (Legal Business Name): WIND OF CHANGE MENTAL HEALTH COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 MAPLE AVE
RED BANK NJ
07701-1764
US

IV. Provider business mailing address

13 HIGH RIDGE RD
OCEAN NJ
07712-3460
US

V. Phone/Fax

Practice location:
  • Phone: 732-997-7008
  • Fax:
Mailing address:
  • Phone: 732-997-7008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID AMAR
Title or Position: OWNER
Credential: LPC
Phone: 646-732-7097