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General NPI Number Information
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NPI Number | 1972860633
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Entity Type | Organization
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Legal Business Name | BALM IN GILEAD COMMUNITY SERVICES, INC
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Dates
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Enumeration Date | 04/19/2012
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 790 CLINTON AVE
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City | NEWARK
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State | NJ
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Zip | 07108-1047
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Country | US
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Telephone | 862-235-0814
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Fax | 973-926-3577
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Provider Business Mailing Address
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Address Line | PO BOX 28038
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City | NEWARK
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State | NJ
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Zip | 07101-1047
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Country | US
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Telephone | 973-517-4488
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Fax | 973-926-3577
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. VIVA L WHITE
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Credential | LCSW
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Telephone | 973-517-4488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37CA00095399
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05454500
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License Number State | NJ
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