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General NPI Number Information
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NPI Number | 1962844415
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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 | 07/25/2013
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Last Update Date | 07/25/2013
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Provider Practice Location Address
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Address Line | 704 COOPER ST
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City | BEVERLY
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State | NJ
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Zip | 08010-1702
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Country | US
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Telephone | 609-880-3025
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Fax | 888-397-1415
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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 | 609-880-3025
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. LEROY SCOTT III
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Credential | M. TH.
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Telephone | 609-880-3025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05221400
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License Number State | NJ
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