Healthcare Provider Details

I. General information

NPI: 1255699013
Provider Name (Legal Business Name): POWER COUNSELING AND TREATMENT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1071 E LANDIS AVE STE 3
VINELAND NJ
08360-4060
US

IV. Provider business mailing address

6828 WALKWAY CT STE B
BRYANS ROAD MD
20616-6106
US

V. Phone/Fax

Practice location:
  • Phone: 202-813-0454
  • Fax: 202-813-0454
Mailing address:
  • Phone: 202-813-0454
  • Fax: 202-813-0454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. AZUBIKE INNOCENT ALICHE
Title or Position: DIRECTOR
Credential: LCSW
Phone: 202-813-0454