Healthcare Provider Details

I. General information

NPI: 1881838779
Provider Name (Legal Business Name): THE LESTER A. DRENK BEHAVIORAL HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 04/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

1289 ROUTE 38
HAINESPORT NJ
08036-2730
US

V. Phone/Fax

Practice location:
  • Phone: 609-835-6180
  • Fax: 609-835-7962
Mailing address:
  • Phone: 609-267-5656
  • Fax: 609-267-8892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number104100000X
License Number StateNJ

VIII. Authorized Official

Name: MS. NEFESSA WIGGINS
Title or Position: CRISIS SPECIALIST
Credential: MSW, LSW
Phone: 609-835-6180