Provider Demographics
NPI:1235526872
Name:AXIS I PROFESSIONAL SERVICES, LLC
Entity Type:Organization
Organization Name:AXIS I PROFESSIONAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:609-238-5120
Mailing Address - Street 1:101 ROUTE 130 S
Mailing Address - Street 2:STE #325
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-2845
Mailing Address - Country:US
Mailing Address - Phone:866-519-3401
Mailing Address - Fax:866-288-5024
Practice Address - Street 1:101 ROUTE 130 S
Practice Address - Street 2:STE #325
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-2845
Practice Address - Country:US
Practice Address - Phone:866-519-3401
Practice Address - Fax:866-288-5024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00387400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty