Healthcare Provider Details

I. General information

NPI: 1861071003
Provider Name (Legal Business Name): FOUNDATIONS FOR LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 PINE ST STE 100
ROCKAWAY NJ
07866-3139
US

IV. Provider business mailing address

41 PINE ST STE 100
ROCKAWAY NJ
07866-3139
US

V. Phone/Fax

Practice location:
  • Phone: 405-426-0791
  • Fax:
Mailing address:
  • Phone: 405-426-0791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN L WELLS
Title or Position: CEO
Credential: LCSW
Phone: 405-426-0791