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General NPI Number Information
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NPI Number | 1376084111
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Entity Type | Organization
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Legal Business Name | WILLOW WELLNESS CENTER
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 304 NEWTON AVE
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City | OAKLYN
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State | NJ
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Zip | 08107-1446
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Country | US
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Telephone | 267-980-0760
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Fax |
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Provider Business Mailing Address
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Address Line | 304 NEWTON AVE
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City | OAKLYN
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State | NJ
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Zip | 08107-1446
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Country | US
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Telephone | 267-980-0760
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | KAREN LYNN DRAPER
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Credential | LPC
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Telephone | 267-980-0760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 37PC000385200
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License Number State | NJ
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