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General NPI Number Information
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NPI Number | 1447570023
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Entity Type | Organization
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Legal Business Name | THE COUNSELING AND WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 06/07/2010
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Last Update Date | 09/13/2010
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Provider Practice Location Address
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Address Line | 11 DUNDAR RD SUITE 212
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City | SPRINGFIELD
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State | NJ
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Zip | 07081-3553
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Country | US
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Telephone | 201-292-4070
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Fax |
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Provider Business Mailing Address
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Address Line | 466 MONMOUTH ST SUITE 4L
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City | JERSEY CITY
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State | NJ
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Zip | 07302-1950
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | PETER J ECONOMOU
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Credential | MA, LPC
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Telephone | 732-822-3242
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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 | 37PC00408200
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License Number State | NJ
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