Provider Demographics
NPI:1033446851
Name:SAND CASTLE COUNSELING SERVICES
Entity Type:Organization
Organization Name:SAND CASTLE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HATTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL-RATLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:856-745-0238
Mailing Address - Street 1:1155 ROUTE 73 STE 12
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-2352
Mailing Address - Country:US
Mailing Address - Phone:856-745-0238
Mailing Address - Fax:
Practice Address - Street 1:1155 ROUTE 73 STE 12
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-2352
Practice Address - Country:US
Practice Address - Phone:856-745-0238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00360300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty