Healthcare Provider Details

I. General information

NPI: 1225194400
Provider Name (Legal Business Name): NEW DAWN COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 SMOKE RISE DR
WARREN NJ
07059-6821
US

IV. Provider business mailing address

736 MOUNTAIN BLVD 2ND FLOOR
WATCHUNG NJ
07069-6243
US

V. Phone/Fax

Practice location:
  • Phone: 732-469-3371
  • Fax:
Mailing address:
  • Phone: 732-469-9996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberLA74183B
License Number StateFL

VIII. Authorized Official

Name: DR. DAWN J LACOSTA
Title or Position: LICENSED CLINICAL PASTORAL COUNSELO
Credential: D.M.DIV.
Phone: 732-469-9996