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General NPI Number Information
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NPI Number | 1003014663
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Entity Type | Organization
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Legal Business Name | SOUTH BROAD STREET COUNSELING SERVICES INC
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Dates
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Enumeration Date | 07/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1418 SOUTH BROAD STREET
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City | TRENTON
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State | NJ
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Zip | 08610
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Country | US
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Telephone | 609-394-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 1418 SOUTH BROAD STREET
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City | TRENTON
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State | NJ
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Zip | 08610
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Country | US
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Telephone | 609-394-8000
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. CLINTON H SCOTT
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Credential | PHD
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Telephone | 609-394-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 2000283
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License Number State | NJ
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