Healthcare Provider Details

I. General information

NPI: 1952886087
Provider Name (Legal Business Name): TEANECK COUNSELING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

771 RIVERVIEW AVE
TEANECK NJ
07666-2268
US

IV. Provider business mailing address

771 RIVERVIEW AVE
TEANECK NJ
07666-2268
US

V. Phone/Fax

Practice location:
  • Phone: 917-306-6484
  • Fax: 201-503-8138
Mailing address:
  • Phone: 917-306-6484
  • Fax: 201-503-8138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DAVIDA N CUMMINS
Title or Position: MANAGING PARTNER
Credential: MS NCC LAC
Phone: 917-306-6484