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General NPI Number Information
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NPI Number | 1700572187
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Entity Type | Organization
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Legal Business Name | MVCG PSYCHOTHERAPY SERVICES, LLC
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Dates
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Enumeration Date | 04/18/2023
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Last Update Date | 06/14/2024
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Provider Practice Location Address
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Address Line | 512 WARREN AVE OFC
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City | SPRING LAKE
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State | NJ
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Zip | 07762-1233
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Country | US
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Telephone | 732-575-0506
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Fax |
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Provider Business Mailing Address
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Address Line | 512 WARREN AVE OFC
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City | SPRING LAKE
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State | NJ
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Zip | 07762-1233
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Country | US
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Telephone | 732-575-0506
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MANUELA VALVENTOS CORREIA-GUERRA
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Credential | MA, LPC, NCC
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Telephone | 732-575-0506
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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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