1255797551 NPI number — GREATER NEW JERSEY CREATIVE COUNSELING

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255797551 NPI number — GREATER NEW JERSEY CREATIVE COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER NEW JERSEY CREATIVE COUNSELING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255797551
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 ROUTE 73 N
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
MARLTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08053-3422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-419-2756
Provider Business Mailing Address Fax Number:
856-817-6017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 ROUTE 73 N
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
MARLTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08053-3422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-419-2756
Provider Business Practice Location Address Fax Number:
856-817-6017
Provider Enumeration Date:
01/04/2016

Additional Information

Authorized Official

Authorized Official Last Name:
DOLAN
Authorized Official First Name:
DOROTHY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
717-419-2756

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  44SCO5540000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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