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General NPI Number Information
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NPI Number | 1023526514
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Entity Type | Organization
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Legal Business Name | WHO DO YOU THINK YOU ARE, LLC
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 07/05/2019
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Provider Practice Location Address
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Address Line | 1225 ROUTE 202 N
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City | BRANCHBURG
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State | NJ
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Zip | 08876-3923
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Country | US
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Telephone | 908-938-4170
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Fax |
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Provider Business Mailing Address
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Address Line | 1225 ROUTE 202 N
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City | BRANCHBURG
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State | NJ
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Zip | 08876-3923
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Country | US
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Telephone | 908-938-4170
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KACEY KONWISER DALTON
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Credential | LPC
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Telephone | 908-938-4170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37PC00369000
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License Number State | NJ
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