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General NPI Number Information
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NPI Number | 1558759324
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Entity Type | Organization
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Legal Business Name | DJB COUNSELING LLC
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Dates
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Enumeration Date | 01/02/2015
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Last Update Date | 01/02/2015
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Provider Practice Location Address
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Address Line | 283 SPARTA AVE
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City | SPARTA
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State | NJ
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Zip | 07871-1162
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Country | US
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Telephone | 203-609-1714
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Fax |
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Provider Business Mailing Address
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Address Line | 283 SPARTA AVENUE
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City | SPARTA
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State | NJ
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Zip | 07871
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Country | US
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Telephone | 203-609-1714
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Fax |
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Authorized Official
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Title or Position | THERAPIST, MEDIATOR,A ND LIFE COACH
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Name | DEJAYE BOTKIN
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Credential | MA, LPC, NCC
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Telephone | 203-609-1714
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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 | 37PC263200
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License Number State | NJ
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