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General NPI Number Information
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NPI Number | 1275958340
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Entity Type | Organization
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Legal Business Name | EAGLES WINGS COUNSELING SERVICES
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Dates
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Enumeration Date | 02/26/2014
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Last Update Date | 02/26/2014
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Provider Practice Location Address
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Address Line | 505 BALSAM RD
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City | CHERRY HILL
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State | NJ
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Zip | 08003-3201
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Country | US
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Telephone | 609-353-4075
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 KINGS HWY N SUITE 207
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City | CHERRY HILL
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State | NJ
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Zip | 08034-2304
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Country | US
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Telephone | 856-298-1367
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Fax | 856-295-2371
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KEISHA SPARROW
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Credential | MA, LPC
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Telephone | 856-298-1367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 374PC00371200
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License Number State | NJ
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