Healthcare Provider Details

I. General information

NPI: 1568066041
Provider Name (Legal Business Name): JP CHRISITIAN COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 11/25/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1256 HARDING AVE
UNION NJ
07083-3738
US

IV. Provider business mailing address

1256 HARDING AVE
UNION NJ
07083-3738
US

V. Phone/Fax

Practice location:
  • Phone: 908-313-0249
  • Fax:
Mailing address:
  • Phone: 908-313-0249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSE PIERRE
Title or Position: PSYCHOTHERAPIST
Credential: LCSW,THD.
Phone: 908-313-0249