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General NPI Number Information
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NPI Number | 1356217806
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Entity Type | Organization
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Legal Business Name | MCKENNA WELLNESS COLLECTIVE
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Dates
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Enumeration Date | 10/13/2025
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 1843 FERNWOOD DR
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City | WEST DEPTFORD
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State | NJ
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Zip | 08096-5751
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Country | US
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Telephone | 609-790-4919
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2
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City | MANTUA
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State | NJ
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Zip | 08051-0002
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Country | US
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Telephone | 609-790-4919
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIMOTHY J MCKENNA
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Credential | LPC
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Telephone | 609-790-4919
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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 |
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License Number State |
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