Provider Demographics
NPI:1194379255
Name:BACK ON TRACK COUNSELING LLC
Entity Type:Organization
Organization Name:BACK ON TRACK COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:SHAKIR
Authorized Official - Last Name:ABDUS-SALAAM
Authorized Official - Suffix:
Authorized Official - Credentials:MHS-C,LPC, LCADC
Authorized Official - Phone:862-217-5144
Mailing Address - Street 1:19 ORANGE PL
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-2019
Mailing Address - Country:US
Mailing Address - Phone:973-474-8441
Mailing Address - Fax:
Practice Address - Street 1:19 ORANGE PL
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-2019
Practice Address - Country:US
Practice Address - Phone:973-474-8441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-27
Last Update Date:2019-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty