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General NPI Number Information
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NPI Number | 1134256712
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Entity Type | Organization
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Legal Business Name | CHILDREN'S CONTINUUM OF CARE
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 177 S CENTRE ST SUITE B
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City | MERCHANTVILLE
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State | NJ
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Zip | 08109-2220
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Country | US
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Telephone | 856-661-1100
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Fax | 856-661-0910
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Provider Business Mailing Address
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Address Line | 177 S CENTRE ST SUITE B
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City | MERCHANTVILLE
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State | NJ
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Zip | 08109-2220
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Country | US
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Telephone | 856-661-1100
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Fax | 856-661-0910
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KIMBERLY C. PETKA
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Credential | LMFT
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Telephone | 856-661-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37FI00158500
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License Number State | NJ
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