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General NPI Number Information
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NPI Number | 1962939793
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Entity Type | Organization
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Legal Business Name | CHANGE AND GROWTH COUNCELING LLC
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 10/05/2017
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Provider Practice Location Address
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Address Line | 195 BUCKINGHAM WAY
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City | SOMERSET
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State | NJ
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Zip | 08873-4927
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Country | US
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Telephone | 732-841-4666
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Fax |
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Provider Business Mailing Address
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Address Line | 195 BUCKINGHAM WAY
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City | SOMERSET
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State | NJ
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Zip | 08873-4927
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Country | US
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Telephone | 732-841-4666
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. BATIA MIRETZKY DRUCKER
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Credential | LCSW
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Telephone | 732-841-4666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 44SC05549900
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License Number State | NJ
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