Provider Demographics
NPI:1144780248
Name:THEOKAS, EDWIGE (LPC)
Entity Type:Individual
Prefix:
First Name:EDWIGE
Middle Name:
Last Name:THEOKAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:PLANTING
Other - Middle Name:
Other - Last Name:SEEDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1 ANNA ROSE CT
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-2270
Mailing Address - Country:US
Mailing Address - Phone:917-686-3898
Mailing Address - Fax:
Practice Address - Street 1:4 W PARK ST STE 125
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-1352
Practice Address - Country:US
Practice Address - Phone:609-817-4747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-23
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00631700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health