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General NPI Number Information
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NPI Number | 1164748968
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Entity Type | Organization
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Legal Business Name | THE CENTER FOR SUCCESSFUL LIVING, LLC
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Dates
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Enumeration Date | 04/19/2010
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Last Update Date | 04/19/2010
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Provider Practice Location Address
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Address Line | 6000 SAGEMORE DR SUITE 6102
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City | MARLTON
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State | NJ
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Zip | 08053-3900
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Country | US
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Telephone | 856-364-2042
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 818
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City | MALAGA
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State | NJ
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Zip | 08328-0818
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHLEEN BONNENBERG
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Credential | LCSW
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Telephone | 856-364-2042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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