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General NPI Number Information
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NPI Number | 1245854272
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Entity Type | Organization
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Legal Business Name | CHAMPION PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 06/05/2020
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Last Update Date | 06/05/2020
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Provider Practice Location Address
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Address Line | 17 BRADFORD AVE APT 13
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City | TRENTON
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State | NJ
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Zip | 08610-3107
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Country | US
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Telephone | 609-638-7560
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 2623
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City | MERCERVILLE
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State | NJ
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Zip | 08619-9998
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Country | US
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Telephone | 609-638-7560
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARMEN LYNN HODGES
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Credential | PSYD, LCADC
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Telephone | 609-638-7560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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