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General NPI Number Information
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NPI Number | 1982040242
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Entity Type | Organization
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Legal Business Name | MANNA COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 05/14/2013
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Last Update Date | 05/14/2013
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Provider Practice Location Address
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Address Line | 354 S BROAD ST STE 119
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City | TRENTON
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State | NJ
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Zip | 08608-2502
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Country | US
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Telephone | 609-382-1213
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Fax |
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Provider Business Mailing Address
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Address Line | 354 S BROAD ST STE 119
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City | TRENTON
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State | NJ
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Zip | 08608-2502
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Country | US
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Telephone | 609-382-1213
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES D HARRIS JR.
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Credential | PHD
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Telephone | 609-382-1213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 37LC00137800
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License Number State | NJ
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