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General NPI Number Information
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NPI Number | 1750829396
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Entity Type | Organization
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Legal Business Name | CORE COUNSELING SOUTH JERSEY, LLC
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Dates
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Enumeration Date | 02/02/2017
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Last Update Date | 02/06/2017
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Provider Practice Location Address
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Address Line | 1000 WHITE HORSE RD SUITE 904
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City | VOORHEES
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State | NJ
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Zip | 08043-4406
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Country | US
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Telephone | 856-866-6331
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Fax | 856-772-9674
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Provider Business Mailing Address
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Address Line | 1000 WHITE HORSE RD SUITE 904
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City | VOORHEES
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State | NJ
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Zip | 08043-4406
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Country | US
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Telephone | 856-866-6331
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Fax | 856-772-9674
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Authorized Official
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Title or Position | OWNER
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Name | ADAM MONDELBLATT
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Credential | LPC
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Telephone | 856-866-6331
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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 | 37PC00485700
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License Number State | NJ
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