Provider Demographics
NPI:1366861940
Name:CHARIS COUNSELING, LLC
Entity Type:Organization
Organization Name:CHARIS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MFT, LPC, NCC
Authorized Official - Phone:856-904-5580
Mailing Address - Street 1:44 COOPER ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-4640
Mailing Address - Country:US
Mailing Address - Phone:856-686-0900
Mailing Address - Fax:
Practice Address - Street 1:44 COOPER ST
Practice Address - Street 2:SUITE 104
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-4640
Practice Address - Country:US
Practice Address - Phone:856-686-0900
Practice Address - Fax:856-845-8011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YP2500X, 261QM0850X, 261QM0855X
NJ251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty