Provider Demographics
NPI:1093932550
Name:THE WOUNDED HEALER, INC. D/B/A MY FRIENDS HOUSE FAMILY COUNSELING SERV
Entity Type:Organization
Organization Name:THE WOUNDED HEALER, INC. D/B/A MY FRIENDS HOUSE FAMILY COUNSELING SERV
Other - Org Name:THE WOUNDED HEALER, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DULUDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-669-6900
Mailing Address - Street 1:371 GLASSBORO ROAD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08097-1026
Mailing Address - Country:US
Mailing Address - Phone:856-669-6900
Mailing Address - Fax:856-384-0366
Practice Address - Street 1:371 GLASSBORO ROAD
Practice Address - Street 2:
Practice Address - City:WOODBURY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08097-1026
Practice Address - Country:US
Practice Address - Phone:856-669-6900
Practice Address - Fax:856-384-0366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23143251S00000X
NJ2000403251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8936404Medicaid