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General NPI Number Information
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NPI Number | 1245375492
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Entity Type | Organization
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Legal Business Name | FOUNDATION FOR FAMILY GUIDANCE CHRISTIAN COUNSELING CENTER
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 01/26/2012
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Provider Practice Location Address
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Address Line | 2003 LINCOLN DR W SUITE A
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City | MARLTON
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State | NJ
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Zip | 08053-1529
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Country | US
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Telephone | 856-751-8700
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Fax | 856-751-3520
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Provider Business Mailing Address
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Address Line | PO BOX 3036
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City | CHERRY HILL
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State | NJ
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Zip | 08034-0274
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Country | US
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Telephone | 856-751-8700
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Fax | 856-751-3520
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. MICHAEL CLAY
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Credential | MSCC
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Telephone | 856-751-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 35S100298900
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License Number State | NJ
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