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General NPI Number Information
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NPI Number | 1861043655
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Entity Type | Organization
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Legal Business Name | DYNAMIC COUNSELING
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Dates
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Enumeration Date | 09/24/2019
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Last Update Date | 09/24/2019
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Provider Practice Location Address
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Address Line | 1930 MARLTON PIKE E STE M68
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City | CHERRY HILL
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State | NJ
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Zip | 08003-4202
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Country | US
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Telephone | 609-929-3485
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Fax |
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Provider Business Mailing Address
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Address Line | 1930 MARLTON PIKE E STE M68
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City | CHERRY HILL
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State | NJ
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Zip | 08003-4202
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Country | US
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Telephone | 609-929-3485
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN GAIL GIBBS
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Credential | MS, LPC
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Telephone | 609-929-3485
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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 |
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License Number State |
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