Healthcare Provider Details

I. General information

NPI: 1255708822
Provider Name (Legal Business Name): DATCHI PSYCHOLOGY AND CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2015
Last Update Date: 08/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 DEFOREST AVE
SUMMIT NJ
07901-2155
US

IV. Provider business mailing address

1480 PLEASANT VALLEY WAY 15
WEST ORANGE NJ
07052-1300
US

V. Phone/Fax

Practice location:
  • Phone: 812-360-5143
  • Fax:
Mailing address:
  • Phone: 812-360-5143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35SI00535000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35SI00535000
License Number StateNJ

VIII. Authorized Official

Name: DR. CORINNE CECILE DATCHI
Title or Position: SINGLE OWNER
Credential: PHD, ABPP
Phone: 812-360-5143