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General NPI Number Information
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NPI Number | 1740801158
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Entity Type | Organization
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Legal Business Name | TIMBUK2 ACADEMY LLC
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Dates
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Enumeration Date | 04/27/2020
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Last Update Date | 04/27/2020
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Provider Practice Location Address
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Address Line | 712 STUYVESANT AVE
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City | TRENTON
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State | NJ
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Zip | 08618-4106
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Country | US
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Telephone | 609-431-2549
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 77047
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City | EWING
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State | NJ
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Zip | 08628-6047
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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 | CEO
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Name | AYANA ABDULRAHEEM
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Credential |
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Telephone | 609-431-2549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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