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General NPI Number Information
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NPI Number | 1114683596
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Entity Type | Organization
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Legal Business Name | TRANQUIL PINES COUNSELING LLC
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Dates
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Enumeration Date | 11/10/2021
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 411 KAILA CT
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City | SHAMONG
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State | NJ
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Zip | 08088-9688
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Country | US
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Telephone | 609-401-2012
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1117
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City | MEDFORD
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State | NJ
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Zip | 08055-6117
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Country | US
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Telephone | 908-294-5898
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Fax |
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Authorized Official
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Title or Position | SOLE MBR
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Name | KATHLEEN ANNE LEE
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Credential | MA, LPC, LCADC, ACS
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Telephone | 908-294-5898
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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 |
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License Number State |
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