MEDICARE: WISHING WELL COMMUNITY CONSULTING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	324500000X	Substance Abuse Rehabilitation Facility
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1477488930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISHING WELL COMMUNITY CONSULTING

Provider Business Mailing Address
First Line	:	215 HIGHLAND AVE STE C
Second Line	:
City	:	HADDON TOWNSHIP
State	:	NJ
Zip	:	08108-2634
Country	:	US
Telephone Number	:	862-324-4375
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 HIGHLAND AVE STE C
Second Line	:
City	:	HADDON TOWNSHIP
State	:	NJ
Zip	:	08108-2634
Country	:	US
Telephone Number	:	862-324-4375
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	GARY DOCK SR.
Credential	:	MA, LCADC
Telephone Number	:	862-324-4375

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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Directions to “WISHING WELL COMMUNITY CONSULTING ” Practice Location

Language	Start Address	Practice Location

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