Healthcare Provider Details

I. General information

NPI: 1437697414
Provider Name (Legal Business Name): CUMBERLAND COUNTY GUIDANCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 E ELMER ST
VINELAND NJ
08360-4725
US

IV. Provider business mailing address

2038 CARMEL RD
MILLVILLE NJ
08332-9754
US

V. Phone/Fax

Practice location:
  • Phone: 856-691-8579
  • Fax: 856-691-8625
Mailing address:
  • Phone: 856-825-6810
  • Fax: 856-327-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number405010148
License Number StateNJ

VIII. Authorized Official

Name: MR. H. DIETER HOVERMANN
Title or Position: EXECUTIVE DIRECTOR
Credential: MA
Phone: 856-825-6810