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General NPI Number Information
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NPI Number | 1396505475
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Entity Type | Organization
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Legal Business Name | BYRDWINGS II
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Dates
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Enumeration Date | 03/19/2024
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 41 CHELSEA CIRCLE
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City | CLEMENTON
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State | NJ
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Zip | 08021
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Country | US
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Telephone | 856-534-0004
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 185
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City | CLEMENTON
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State | NJ
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Zip | 08021
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Country | US
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Telephone | 856-534-0004
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRENDA J BYRD
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Credential | LPC, LCADC
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Telephone | 856-534-0004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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