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General NPI Number Information
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NPI Number | 1679087712
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Entity Type | Organization
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Legal Business Name | FAMILY THERAPY AND CONSULTATION SERVICES
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Dates
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Enumeration Date | 11/28/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 1 LUPTON AVE
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City | WOODBURY
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State | NJ
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Zip | 08096-5901
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Country | US
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Telephone | 856-332-4698
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Fax | 856-415-7574
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Provider Business Mailing Address
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Address Line | 1 LUPTON AVE
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City | WOODBURY
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State | NJ
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Zip | 08096-5901
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Country | US
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Telephone | 856-332-4698
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Fax | 856-415-7574
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | NANCY KLINE GOLD
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Credential |
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Telephone | 856-332-4698
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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 | 37PC00150900
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License Number State | NJ
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