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General NPI Number Information
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NPI Number | 1831482397
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Entity Type | Organization
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Legal Business Name | IMPACT COUNSELING LLC
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Dates
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Enumeration Date | 05/17/2011
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Last Update Date | 05/17/2011
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Provider Practice Location Address
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Address Line | 255 MONMOUTH RD
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City | OAKHURST
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State | NJ
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Zip | 07755-1515
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Country | US
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Telephone | 732-531-6868
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Fax | 732-531-6969
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Provider Business Mailing Address
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Address Line | 255 MONMOUTH RD
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City | OAKHURST
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State | NJ
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Zip | 07755-1515
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Country | US
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Telephone | 732-531-6868
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Fax | 732-531-6969
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BENJAMIN ALEX LEIBOWITZ
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Credential | MA,PD
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Telephone | 732-531-6868
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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 | 37PC00090800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 37F1000035800
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License Number State | NJ
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