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General NPI Number Information
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NPI Number | 1689292138
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Entity Type | Organization
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Legal Business Name | CRESTING WAVE COUNSELING
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Dates
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Enumeration Date | 07/10/2020
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Last Update Date | 06/07/2021
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Provider Practice Location Address
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Address Line | 7 GREYLYNNE CT
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City | HOLMDEL
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State | NJ
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Zip | 07733-2372
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Country | US
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Telephone | 848-863-9097
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Fax |
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Provider Business Mailing Address
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Address Line | 200 VILLAGE CENTER DR UNIT 6164
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City | FREEHOLD
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State | NJ
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Zip | 07728-2688
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIM MILLER
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Credential | LPC
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Telephone | 848-863-9097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral 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 | 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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