Provider Demographics
NPI:1619488541
Name:CLEAR CONSCIENCE COUNSELING, LLC
Entity Type:Organization
Organization Name:CLEAR CONSCIENCE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GORE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCADC
Authorized Official - Phone:973-454-6711
Mailing Address - Street 1:21 BRANDYWINE CIR
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-2704
Mailing Address - Country:US
Mailing Address - Phone:973-454-6711
Mailing Address - Fax:732-756-1021
Practice Address - Street 1:2509 PARK AVE STE 2B
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5369
Practice Address - Country:US
Practice Address - Phone:973-435-2881
Practice Address - Fax:732-756-1021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00590800261QM0801X
NJ37LC00233200261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder