Provider Demographics
NPI:1023402443
Name:TRUE COLORS CENTER FOR CREATIVE THERAPY, LLC
Entity Type:Organization
Organization Name:TRUE COLORS CENTER FOR CREATIVE THERAPY, LLC
Other - Org Name:JENNIFER WHITLOCK, LPC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:WENONAH
Authorized Official - Last Name:WHITLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:973-222-3750
Mailing Address - Street 1:93 MAIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-2056
Mailing Address - Country:US
Mailing Address - Phone:973-222-3750
Mailing Address - Fax:
Practice Address - Street 1:93 MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2056
Practice Address - Country:US
Practice Address - Phone:973-222-3750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00021200251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health