Provider Demographics
NPI:1558859702
Name:THE WOUNDED HEALER, INC. D/B/A MY FRIENDS HOUSE FAMILY COUNSELING SERV
Entity Type:Organization
Organization Name:THE WOUNDED HEALER, INC. D/B/A MY FRIENDS HOUSE FAMILY COUNSELING SERV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGUARINA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:856-669-6900
Mailing Address - Street 1:339 N ROUTE 73
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-9707
Mailing Address - Country:US
Mailing Address - Phone:856-669-0292
Mailing Address - Fax:856-767-2632
Practice Address - Street 1:339 N ROUTE 73
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-9707
Practice Address - Country:US
Practice Address - Phone:856-669-0292
Practice Address - Fax:856-767-2632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2000662251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health