Healthcare Provider Details

I. General information

NPI: 1578283115
Provider Name (Legal Business Name): ANGELA D.C. GELIN LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 09/02/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 ROUTE 168 STE 104
TURNERSVILLE NJ
08012-3224
US

IV. Provider business mailing address

2033 BROADACRES DR
CLEMENTON NJ
08021-5629
US

V. Phone/Fax

Practice location:
  • Phone: 856-677-8535
  • Fax:
Mailing address:
  • Phone: 609-369-4679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37AC00670200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: