Provider Demographics
NPI:1194223271
Name:NEW LIFE COUNSELING AND MENTAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:NEW LIFE COUNSELING AND MENTAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:IDRIS
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:973-748-0847
Mailing Address - Street 1:12 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3211
Mailing Address - Country:US
Mailing Address - Phone:973-748-0847
Mailing Address - Fax:973-259-3706
Practice Address - Street 1:12 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3211
Practice Address - Country:US
Practice Address - Phone:973-748-0847
Practice Address - Fax:973-259-3706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NJ261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0457019Medicaid
NJ0457671Medicaid