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General NPI Number Information
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NPI Number | 1124806013
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Entity Type | Organization
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Legal Business Name | ESSENCE OF LIFE THERAPEUTIC SERVICES LLC
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Dates
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Enumeration Date | 09/20/2023
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Last Update Date | 09/20/2023
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Provider Practice Location Address
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Address Line | 7 DEMARET CT
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City | LITTLE EGG HARBOR TWP
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State | NJ
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Zip | 08087-1808
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Country | US
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Telephone | 609-857-1582
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Fax |
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Provider Business Mailing Address
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Address Line | 7 DEMARET CT
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City | LITTLE EGG HARBOR TWP
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State | NJ
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Zip | 08087-1808
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Country | US
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Telephone | 609-857-1582
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | TATIANA NEGRON
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Credential |
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Telephone | 732-795-5519
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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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