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General NPI Number Information
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NPI Number | 1487146403
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Entity Type | Individual
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Provider Name | LUGENIA SMALL
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Gender | Female
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Dates
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Enumeration Date | 06/05/2018
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Last Update Date | 06/05/2018
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Provider Practice Location Address
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Address Line | 4 EAKIN ST STE 4A
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City | SALEM
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State | NJ
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Zip | 08079-1704
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Country | US
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Telephone | 609-665-1102
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Fax |
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Provider Business Mailing Address
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Address Line | 10530 IVY CLOSE RD
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-5668
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00520300
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License Number State | NJ
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