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General NPI Number Information
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NPI Number | 1366766438
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Entity Type | Organization
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Legal Business Name | HEALTHMARK COUNSELING, LLC
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Dates
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Enumeration Date | 03/18/2010
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Last Update Date | 03/18/2010
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Provider Practice Location Address
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Address Line | 101 ROUTE 130 S MADISON BUILDING, SUITE 321
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City | CINNAMINSON
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State | NJ
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Zip | 08077-2845
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Country | US
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Telephone | 856-829-3385
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Fax |
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Provider Business Mailing Address
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Address Line | 101 ROUTE 130 S MADISON BUILDING, SUITE 321
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City | CINNAMINSON
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State | NJ
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Zip | 08077-2845
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Country | US
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Telephone | 856-829-3385
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MICHAEL VINCENT PALMER
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Credential | PH.D.
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Telephone | 856-829-3385
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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 | 37PC00305000
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License Number State | NJ
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