Provider Demographics
NPI:1518335249
Name:WAY OF THE SPIRIT COUNSELING SERVICES INC
Entity Type:Organization
Organization Name:WAY OF THE SPIRIT COUNSELING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:P
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-963-0500
Mailing Address - Street 1:1116 N 19TH STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08105
Mailing Address - Country:US
Mailing Address - Phone:856-963-7323
Mailing Address - Fax:856-963-7324
Practice Address - Street 1:2600 MOUNT EPHRAIM AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08104-3236
Practice Address - Country:US
Practice Address - Phone:856-963-7323
Practice Address - Fax:856-963-7324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-11
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QR0401X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0492043LRMedicaid