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General NPI Number Information
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NPI Number | 1013386150
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Entity Type | Organization
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Legal Business Name | INTENTIONAL HEARTS COUNSELING SERVICES
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 09/18/2015
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Provider Practice Location Address
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Address Line | 1806 HIGHWAY 35 SUITE 203B
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City | OAKHURST
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State | NJ
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Zip | 07755-2700
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Country | US
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Telephone | 732-853-3050
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Fax |
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Provider Business Mailing Address
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Address Line | 6 GOLFVIEW DR
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City | NEPTUNE
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State | NJ
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Zip | 07753-2933
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LORI MICHELLE NIXON
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Credential | LPC
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Telephone | 732-853-3050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00432100
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License Number State | NJ
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