Healthcare Provider Details

I. General information

NPI: 1144639725
Provider Name (Legal Business Name): DRENA GWIN MA, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 E CHESTNUT AVE
VINELAND NJ
08360-5053
US

IV. Provider business mailing address

770 WOODLANE RD
MT. HOLLY NJ
08060
US

V. Phone/Fax

Practice location:
  • Phone: 856-696-1233
  • Fax: 856-696-1789
Mailing address:
  • Phone: 609-267-5928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: