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General NPI Number Information
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NPI Number | 1750097440
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Entity Type | Organization
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Legal Business Name | MIND WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 01/25/2023
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Last Update Date | 01/25/2023
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Provider Practice Location Address
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Address Line | 409 MAIN ST
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City | CHESTER
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State | NJ
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Zip | 07930-2526
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Country | US
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Telephone | 908-409-3515
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Fax | 862-219-5590
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Provider Business Mailing Address
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Address Line | 10 CHIDESTER RD
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City | RANDOLPH
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State | NJ
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Zip | 07869-3478
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Country | US
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Telephone | 908-409-3515
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Fax | 862-219-5590
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Authorized Official
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Title or Position | OWNER
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Name | MARIE HARTZEL
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Credential | LPC
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Telephone | 908-409-3515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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