Provider Demographics
NPI:1184862443
Name:TIMOTHY FAITH SERVICES, LLC
Entity Type:Organization
Organization Name:TIMOTHY FAITH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC, MC
Authorized Official - Phone:609-970-4680
Mailing Address - Street 1:101 STONEHAM DR
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-3001
Mailing Address - Country:US
Mailing Address - Phone:609-970-4680
Mailing Address - Fax:
Practice Address - Street 1:101 STONEHAM DR
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-3001
Practice Address - Country:US
Practice Address - Phone:609-970-4680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-25
Last Update Date:2009-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00250000101YP2500X, 251S00000X, 302F00000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Single Specialty