Provider Demographics
NPI:1124379623
Name:AUTHENTIC HEALING, LLC
Entity Type:Organization
Organization Name:AUTHENTIC HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KARISHMA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAWLA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:609-318-4325
Mailing Address - Street 1:88 ORCHARD RD
Mailing Address - Street 2:SUITE 2-3
Mailing Address - City:SKILLMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08558-2642
Mailing Address - Country:US
Mailing Address - Phone:609-318-4325
Mailing Address - Fax:
Practice Address - Street 1:88 ORCHARD RD
Practice Address - Street 2:SUITE 2-3
Practice Address - City:SKILLMAN
Practice Address - State:NJ
Practice Address - Zip Code:08558-2642
Practice Address - Country:US
Practice Address - Phone:609-318-4325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00435400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty