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General NPI Number Information
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NPI Number | 1629284419
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Entity Type | Organization
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Legal Business Name | INNOVA COUNSELING AND WELLNESS CENTER, INC.
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 12/15/2014
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Provider Practice Location Address
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Address Line | 681 HIGH MOUNTAIN RD
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City | NORTH HALEDON
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State | NJ
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Zip | 07508-2723
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Country | US
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Telephone | 973-427-3255
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Fax |
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Provider Business Mailing Address
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Address Line | 681 HIGH MOUNTAIN RD
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City | NORTH HALEDON
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State | NJ
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Zip | 07508-2723
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Country | US
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Telephone | 973-427-3255
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT PSYCHOLOGIST
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Name | DR. SUSAN J CREANGE
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Credential | PH.D
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Telephone | 973-427-3255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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