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General NPI Number Information
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NPI Number | 1255708822
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Entity Type | Organization
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Legal Business Name | DATCHI PSYCHOLOGY AND CONSULTING LLC
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Dates
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Enumeration Date | 08/30/2015
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Last Update Date | 08/30/2015
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Provider Practice Location Address
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Address Line | 35 DEFOREST AVE
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City | SUMMIT
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State | NJ
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Zip | 07901-2155
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Country | US
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Telephone | 812-360-5143
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Fax |
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Provider Business Mailing Address
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Address Line | 1480 PLEASANT VALLEY WAY 15
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City | WEST ORANGE
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State | NJ
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Zip | 07052-1300
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Country | US
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Telephone | 812-360-5143
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Fax |
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Authorized Official
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Title or Position | SINGLE OWNER
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Name | DR. CORINNE CECILE DATCHI
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Credential | PHD, ABPP
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Telephone | 812-360-5143
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 35SI00535000
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License Number State | NJ
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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 | 35SI00535000
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License Number State | NJ
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