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General NPI Number Information
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NPI Number | 1124984828
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Entity Type | Organization
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Legal Business Name | THE 4WALLS FOUNDATION
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Dates
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Enumeration Date | 12/27/2025
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Last Update Date | 12/27/2025
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Provider Practice Location Address
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Address Line | 113 WHITE HORSE RD W STE 4
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City | VOORHEES
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State | NJ
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Zip | 08043-3671
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Country | US
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Telephone | 856-650-6556
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 201
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City | SOMERDALE
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State | NJ
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Zip | 08083-0201
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Country | US
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Telephone | 856-650-6556
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JASON ALI BRICE SR.
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Credential | LPC, LCADC
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Telephone | 856-650-6556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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