Provider Demographics
NPI:1194028464
Name:JACQUELINE SPENCER MEMORIAL COUNSELING CENTER
Entity Type:Organization
Organization Name:JACQUELINE SPENCER MEMORIAL COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORNELIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-623-2258
Mailing Address - Street 1:16 STRATFORD PL
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07108-2846
Mailing Address - Country:US
Mailing Address - Phone:973-623-2258
Mailing Address - Fax:
Practice Address - Street 1:16 STRATFORD PL
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07108-2846
Practice Address - Country:US
Practice Address - Phone:973-623-2258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health