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General NPI Number Information
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NPI Number | 1467990044
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Entity Type | Organization
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Legal Business Name | WHOLE FAMILY WELLNESS CENTER LLC
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Dates
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Enumeration Date | 02/03/2017
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Last Update Date | 02/03/2017
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Provider Practice Location Address
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Address Line | 99 KINDERKAMACK RD SUITE 100
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City | WESTWOOD
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State | NJ
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Zip | 07675-3012
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Country | US
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Telephone | 201-723-1776
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Fax |
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Provider Business Mailing Address
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Address Line | 20 BROAD TER
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City | BLOOMFIELD
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State | NJ
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Zip | 07003-2726
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Country | US
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Telephone | 201-723-1776
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TRISHA SANDERS
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Credential | LCSW
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Telephone | 201-723-1776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05368100
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License Number State | NJ
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