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General NPI Number Information
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NPI Number | 1699297762
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Entity Type | Organization
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Legal Business Name | COUNSELING ASSOCIATES NJ LLC
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Dates
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Enumeration Date | 07/11/2017
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Last Update Date | 07/11/2017
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Provider Practice Location Address
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Address Line | 603 W COUNTY LINE RD
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City | LAKEWOOD
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State | NJ
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Zip | 08701-1216
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Country | US
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Telephone | 732-814-6969
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Fax |
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Provider Business Mailing Address
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Address Line | 603 W COUNTY LINE RD
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City | LAKEWOOD
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State | NJ
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Zip | 08701-1216
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Country | US
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Telephone | 732-814-6969
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | NACHUM WEISS
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Credential | LPC
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Telephone | 732-814-6969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37AC00132500
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License Number State | NJ
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