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General NPI Number Information
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NPI Number | 1689143372
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Entity Type | Organization
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Legal Business Name | THE SOLASTA GROUP
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Dates
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Enumeration Date | 11/25/2018
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Last Update Date | 11/25/2018
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Provider Practice Location Address
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Address Line | 56 GINGER DR
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City | LUMBERTON
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State | NJ
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Zip | 08048-4204
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Country | US
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Telephone | 609-746-0146
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Fax |
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Provider Business Mailing Address
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Address Line | 56 GINGER DR
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City | LUMBERTON
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State | NJ
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Zip | 08048-4204
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Country | US
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Telephone | 609-746-0146
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR OF OPERATIONS
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Name | JACQUELINE GARTH
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Credential | MS, LCADC
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Telephone | 609-568-6916
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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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