Provider Demographics
NPI:1073837027
Name:CENTER FOR DYNAMIC GROWTH
Entity Type:Organization
Organization Name:CENTER FOR DYNAMIC GROWTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:POVIA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:609-588-9989
Mailing Address - Street 1:2137 ROUTE 33
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-1740
Mailing Address - Country:US
Mailing Address - Phone:609-588-9989
Mailing Address - Fax:
Practice Address - Street 1:2137 ROUTE 33
Practice Address - Street 2:SUITE 3
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-1740
Practice Address - Country:US
Practice Address - Phone:609-588-9989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-19
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health