=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982963260
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY GUIDANCE CENTER CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2012
-----------------------------------------------------
Last Update Date | 05/08/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 946 EDGEWOOD AVE
-----------------------------------------------------
City | TRENTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08618-5304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-587-6641
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1931 NOTTINGHAM WAY
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08619-3554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-586-0668
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. MARK LAMAR
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 609-586-0668
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 2000206
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------