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General NPI Number Information
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NPI Number | 1568402956
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Entity Type | Organization
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Legal Business Name | RENAISSANCE CHALLENGE CONQUERER TRAINING CENTER INC
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 01/24/2008
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Provider Practice Location Address
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Address Line | 400 7TH AVE
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City | NEWARK
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State | NJ
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Zip | 07107-1697
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Country | US
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Telephone | 973-481-3431
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Fax |
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Provider Business Mailing Address
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Address Line | 400 7TH AVE
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City | NEWARK
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State | NJ
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Zip | 07107-1697
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Country | US
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Telephone | 973-481-3431
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. THOMAS REDDICK
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Credential |
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Telephone | 973-481-3431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | PC003003
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License Number State | NJ
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