Provider Demographics
NPI:1407615602
Name:DENISE BOTT LPC
Entity Type:Organization
Organization Name:DENISE BOTT LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:856-553-5255
Mailing Address - Street 1:6 ENTERPRISE CT
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-4112
Mailing Address - Country:US
Mailing Address - Phone:856-553-5255
Mailing Address - Fax:
Practice Address - Street 1:6 ENTERPRISE CT
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-4112
Practice Address - Country:US
Practice Address - Phone:856-553-5255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health