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General NPI Number Information
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NPI Number | 1619509288
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Entity Type | Organization
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Legal Business Name | SOUTH JERSEY COPING CLINIC LLC
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Dates
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Enumeration Date | 02/11/2020
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 751 ROUTE 73 N STE 11
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City | MARLTON
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State | NJ
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Zip | 08053-3456
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Country | US
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Telephone | 856-267-3182
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Fax | 856-389-3134
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Provider Business Mailing Address
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Address Line | 751 ROUTE 73 N STE 11
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City | SICKLERVILLE
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State | NJ
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Zip | 08081
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Country | US
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Telephone | 267-225-1972
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Fax | 856-389-3134
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Authorized Official
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Title or Position | OWNER
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Name | MRS. VANESSA WOODS
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Credential | LPC
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Telephone | 856-267-3182
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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