Provider Demographics
NPI:1285844050
Name:WELLSPRINGS COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:WELLSPRINGS COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRO-MENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MCSW
Authorized Official - Phone:201-956-6363
Mailing Address - Street 1:22-08 STATE RT 208
Mailing Address - Street 2:SUITE 16
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2609
Mailing Address - Country:US
Mailing Address - Phone:201-956-6363
Mailing Address - Fax:201-956-6026
Practice Address - Street 1:22-08 STATE RT 208
Practice Address - Street 2:SUITE 16
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2609
Practice Address - Country:US
Practice Address - Phone:201-956-6363
Practice Address - Fax:201-956-6026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051917001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty