Provider Demographics
NPI:1578843660
Name:SOLSTICE COUNSELING SERVICES CORP.
Entity Type:Organization
Organization Name:SOLSTICE COUNSELING SERVICES CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDALE
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:609-288-8844
Mailing Address - Street 1:300 BIRMINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:PEMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08068-1326
Mailing Address - Country:US
Mailing Address - Phone:609-288-8844
Mailing Address - Fax:609-288-7210
Practice Address - Street 1:300 BIRMINGHAM RD
Practice Address - Street 2:
Practice Address - City:PEMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08068-1326
Practice Address - Country:US
Practice Address - Phone:609-288-8844
Practice Address - Fax:609-288-7210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2000499-11261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0535797Medicaid
NJ0280925Medicaid