Healthcare Provider Details

I. General information

NPI: 1538064530
Provider Name (Legal Business Name): CHAMYLAH GENERAL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 MORRIS AVE
UNION NJ
07083-5714
US

IV. Provider business mailing address

10 HILL ST APT 7Y
NEWARK NJ
07102-5615
US

V. Phone/Fax

Practice location:
  • Phone: 908-291-2727
  • Fax: 908-291-1211
Mailing address:
  • Phone: 347-608-8327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00727500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: