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General NPI Number Information
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NPI Number | 1447756770
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Entity Type | Organization
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Legal Business Name | YOUR PLACE FOR COUNSELING
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 04/04/2018
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Provider Practice Location Address
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Address Line | 8008 ROUTE 130
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City | DELRAN
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State | NJ
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Zip | 08075-1869
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Country | US
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Telephone | 800-497-9729
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Fax |
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Provider Business Mailing Address
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Address Line | 510 PRINCESS AVE
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City | CROYDON
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State | PA
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Zip | 19021-6024
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Country | US
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Telephone | 215-253-1010
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Fax |
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Authorized Official
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Title or Position | COO
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Name | ELRITA M GODBOLD
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Credential | LCSW
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Telephone | 800-497-9729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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