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General NPI Number Information
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NPI Number | 1124665708
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Entity Type | Organization
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Legal Business Name | SUPPLANTER COUNSELING & MEDIATION, LLC
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Dates
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Enumeration Date | 12/03/2019
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Last Update Date | 04/29/2020
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Provider Practice Location Address
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Address Line | 1330 PARKWAY AVE STE 7
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City | EWING
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State | NJ
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Zip | 08628-3006
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Country | US
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Telephone | 609-454-3080
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Fax | 609-454-3078
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Provider Business Mailing Address
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Address Line | 1330 PARKWAY AVE STE 12
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City | EWING
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State | NJ
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Zip | 08628-3006
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Country | US
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Telephone | 609-454-3080
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Fax | 609-454-3078
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Authorized Official
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Title or Position | OWNER
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Name | MS. JACQUELINE C PORTER- STEWART
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Credential | LCADC, LCSW, SAP
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Telephone | 609-454-3080
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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 |
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License Number State |
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