=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346094794
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRATIVE WELLNESS COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2024
-----------------------------------------------------
Last Update Date | 03/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 MADISON AVE
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07940-1480
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-867-8020
-----------------------------------------------------
Fax | 973-377-7129
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 643
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07940-0643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-867-8020
-----------------------------------------------------
Fax | 973-377-7129
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | BETTY A HOSKINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-867-8020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------