Provider Demographics
NPI:1326412008
Name:THE COUNSELING AND MINDFULNESS GROUP
Entity Type:Organization
Organization Name:THE COUNSELING AND MINDFULNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, LCADC
Authorized Official - Phone:908-303-3850
Mailing Address - Street 1:121 SHELLEY DR
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-2530
Mailing Address - Country:US
Mailing Address - Phone:908-303-3850
Mailing Address - Fax:908-979-1600
Practice Address - Street 1:121 SHELLEY DR
Practice Address - Street 2:SUITE 2E
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2530
Practice Address - Country:US
Practice Address - Phone:908-303-3850
Practice Address - Fax:908-979-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00179200101YA0400X
NJ37PC00496100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty