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General NPI Number Information
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NPI Number | 1427213503
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Entity Type | Organization
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Legal Business Name | EVERGREEN HEALTH AND WELLNES GROUP
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Dates
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Enumeration Date | 07/28/2008
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Last Update Date | 08/26/2008
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Provider Practice Location Address
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Address Line | 136 FRANKLIN CORNER ROAD
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City | LAWRENCVILLE
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State | NJ
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Zip | 08648
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Country | US
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Telephone | 609-586-9050
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Fax |
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Provider Business Mailing Address
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Address Line | 136 FRANKLIN CORNER ROAD
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City | LAWRENCVILLE
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State | NJ
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Zip | 08648
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Country | US
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Telephone | 609-586-9050
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | THOMAS BELL
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Credential |
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Telephone | 609-586-9050
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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