=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750261558
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SELAH WITH VANESSA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2025
-----------------------------------------------------
Last Update Date | 09/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 180 CENTRAL AVE
-----------------------------------------------------
City | NORTH HALEDON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07508-2560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-264-9594
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 180 CENTRAL AVE
-----------------------------------------------------
City | NORTH HALEDON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07508-2560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-264-9594
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PROFESSIONAL COUNSELOR
-----------------------------------------------------
Name | VANESSA CAMPO
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 973-264-9594
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------