Provider Demographics
NPI:1003330846
Name:POWER HOUSE PSYCHOTHERAPY & ADDICTION, LLC
Entity Type:Organization
Organization Name:POWER HOUSE PSYCHOTHERAPY & ADDICTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TEMITOPE
Authorized Official - Middle Name:SHAKIRAT
Authorized Official - Last Name:COATES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCADC, CCS
Authorized Official - Phone:973-878-3900
Mailing Address - Street 1:654 MOUNT PROSPECT AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-3110
Mailing Address - Country:US
Mailing Address - Phone:973-878-3900
Mailing Address - Fax:973-878-3809
Practice Address - Street 1:654 MOUNT PROSPECT AVE STE 201
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-3110
Practice Address - Country:US
Practice Address - Phone:862-888-8146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2019-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
37LC00242600101YA0400X
NJ44SC056678001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty