Healthcare Provider Details

I. General information

NPI: 1326442971
Provider Name (Legal Business Name): COUNSELING CENTER AT TOMS RIVER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2014
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1198 LAKEWOOD RD SUITE 102
TOMS RIVER NJ
08753-2237
US

IV. Provider business mailing address

1198 LAKEWOOD RD SUITE 102
TOMS RIVER NJ
08753-2237
US

V. Phone/Fax

Practice location:
  • Phone: 732-736-6559
  • Fax:
Mailing address:
  • Phone: 732-736-6559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number2000528
License Number StateNJ

VIII. Authorized Official

Name: MS. LINDA R BURNS
Title or Position: CHIEF NSG & LICENSING OFFICER
Credential: RN, CARN
Phone: 561-951-8341