Healthcare Provider Details

I. General information

NPI: 1750692224
Provider Name (Legal Business Name): SANIETRA ECCKLES B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218A SUNSET RD SCREENING, CRISIS, & INTERVENTION (SCIP)
WILLINGBORO NJ
08046-1110
US

IV. Provider business mailing address

2 HONEY LOCUST LN
MOUNT HOLLY NJ
08060-4346
US

V. Phone/Fax

Practice location:
  • Phone: 609-835-6180
  • Fax: 609-835-7962
Mailing address:
  • Phone: 609-954-6326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: