Provider Demographics
NPI:1437625381
Name:SEAWOLF YOGA LLC
Entity Type:Organization
Organization Name:SEAWOLF YOGA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:II
Authorized Official - Credentials:LPC
Authorized Official - Phone:609-703-2810
Mailing Address - Street 1:411 N. CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:VENTOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08406-1753
Mailing Address - Country:US
Mailing Address - Phone:609-703-2810
Mailing Address - Fax:609-377-8120
Practice Address - Street 1:222 NEW RD. SUITE 405 CENTRAL PARK EAST
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221
Practice Address - Country:US
Practice Address - Phone:609-377-8118
Practice Address - Fax:609-377-8120
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEAWOLF YOGA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty