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General NPI Number Information
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NPI Number | 1043451594
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Entity Type | Organization
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Legal Business Name | COUNSELING CENTER FOR TRAUMA AND GRIEF A NJ NONPROFIT CORPORATION
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Dates
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Enumeration Date | 03/12/2009
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Last Update Date | 02/16/2010
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Provider Practice Location Address
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Address Line | 212 W ROUTE 38 SUITE 200
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City | MOORESTOWN
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State | NJ
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Zip | 08057-3238
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Country | US
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Telephone | 856-834-1181
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Fax | 856-834-1183
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Provider Business Mailing Address
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Address Line | PO BOX 316
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City | MOUNT LAUREL
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State | NJ
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Zip | 08054-0316
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Country | US
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Telephone | 856-834-1181
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Fax | 856-834-1183
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Authorized Official
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Title or Position | DIRECTOR OF CLIENT SERVICES
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Name | MS. MARGARET A BLONG
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Credential |
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Telephone | 856-834-1181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC00031900
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License Number State | NJ
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