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General NPI Number Information
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NPI Number | 1912101155
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Entity Type | Organization
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Legal Business Name | FAITH CHRISTIAN COUNSELING CENTER INC
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 215 LOCUST ST
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City | BEVERLY
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State | NJ
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Zip | 08010
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Country | US
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Telephone | 609-877-4411
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Fax | 888-201-7278
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Provider Business Mailing Address
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Address Line | 39 SOMERSET DR
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City | WILLINGBORO
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State | NJ
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Zip | 08046-1433
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Country | US
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Telephone | 608-346-0619
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Fax | 888-201-7278
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. LEROY SCOTT III
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Credential |
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Telephone | 609-346-0619
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 44SC00576900
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License Number State | NJ
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