Provider Demographics
NPI:1275958340
Name:EAGLES WINGS COUNSELING SERVICES
Entity Type:Organization
Organization Name:EAGLES WINGS COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARROW
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:856-298-1367
Mailing Address - Street 1:1500 KINGS HWY N
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2304
Mailing Address - Country:US
Mailing Address - Phone:856-298-1367
Mailing Address - Fax:856-295-2371
Practice Address - Street 1:505 BALSAM RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-3201
Practice Address - Country:US
Practice Address - Phone:609-353-4075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ374PC00371200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty