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General NPI Number Information
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NPI Number | 1336665140
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL & HOLISTIC HEALING CENTER LLC
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Dates
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Enumeration Date | 08/15/2017
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Last Update Date | 08/15/2017
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Provider Practice Location Address
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Address Line | 185 PETERSBURG RD
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City | WOODBINE
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State | NJ
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Zip | 08270-9439
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Country | US
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Telephone | 609-408-0818
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 565
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City | WOODBINE
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State | NJ
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Zip | 08270-0565
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Country | US
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Telephone | 609-408-0818
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. MARCEL M TABONE
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Credential | PSY D, MSW
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Telephone | 609-408-0818
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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 | 35SI00500500
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License Number State | NJ
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