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General NPI Number Information
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NPI Number | 1265852933
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Entity Type | Organization
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Legal Business Name | ABT COUNSELING PLLC
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 1010 HADDONFIELD BERLIN RD STE 300
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City | VOORHEES
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State | NJ
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Zip | 08043-3514
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Country | US
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Telephone | 602-741-6173
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 HADDONFIELD BERLIN RD STE 300
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City | VOORHEES
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State | NJ
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Zip | 08043-3514
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Country | US
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Telephone | 602-741-6173
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MS. ANDREA LAYNE BUSH-TYLDSLEY
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Credential | M.ED LPC
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Telephone | 602-741-6173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 37PC00160900
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License Number State | NJ
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