Provider Demographics
NPI:1568133478
Name:PLAYROOM COUNSELING CENTER
Entity Type:Organization
Organization Name:PLAYROOM COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TUNISIA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MCKNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:551-404-5391
Mailing Address - Street 1:572 TILLMAN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-1719
Mailing Address - Country:US
Mailing Address - Phone:155-140-4539
Mailing Address - Fax:
Practice Address - Street 1:572 TILLMAN ST
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205-1719
Practice Address - Country:US
Practice Address - Phone:155-140-4539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health