Healthcare Provider Details

I. General information

NPI: 1992637078
Provider Name (Legal Business Name): RIANNA KRISTA DI JESUS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 N MAIN ST STE B3
WILLIAMSTOWN NJ
08094-1475
US

IV. Provider business mailing address

135 S BLACK HORSE PIKE #36
WILLIAMSTOWN NJ
08094
US

V. Phone/Fax

Practice location:
  • Phone: 856-777-3178
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37AC00946100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: