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General NPI Number Information
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NPI Number | 1366829079
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Entity Type | Organization
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Legal Business Name | CENTER FOR COUNSELING AND MINDFUL LIVING, LLC
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Dates
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Enumeration Date | 05/01/2015
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Last Update Date | 04/28/2023
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Provider Practice Location Address
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Address Line | 257 US HIGHWAY 22 SUITE B
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City | GREEN BROOK
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State | NJ
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Zip | 08812-1807
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Country | US
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Telephone | 908-516-8422
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 629
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City | PRINCETON
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State | NJ
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Zip | 08542-0629
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Country | US
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Telephone | 908-516-8422
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | MS. VANESSA H. CHAFOS
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Credential | PH.D.
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Telephone | 908-516-8422
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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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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00515300
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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