Provider Demographics
NPI:1477687812
Name:FICTRE COUNSELING SERVICE
Entity Type:Organization
Organization Name:FICTRE COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTENSIVE WITHIN COMMUNITY PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:-
Authorized Official - Last Name:WITHERSPOON
Authorized Official - Suffix:
Authorized Official - Credentials:MASTER OF HUMAN SERV
Authorized Official - Phone:856-573-7742
Mailing Address - Street 1:111 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MT. HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060
Mailing Address - Country:US
Mailing Address - Phone:856-573-7742
Mailing Address - Fax:
Practice Address - Street 1:111 HIGH STREET
Practice Address - Street 2:
Practice Address - City:MT. HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060
Practice Address - Country:US
Practice Address - Phone:856-573-7742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0059986101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty