Provider Demographics
NPI:1619663747
Name:LOGOS CHRISTIAN COUNSELING, INC.
Entity Type:Organization
Organization Name:LOGOS CHRISTIAN COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:862-242-0060
Mailing Address - Street 1:14 HENRY ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2977
Mailing Address - Country:US
Mailing Address - Phone:862-242-0060
Mailing Address - Fax:
Practice Address - Street 1:14 HENRY ST APT 3
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2977
Practice Address - Country:US
Practice Address - Phone:862-242-0060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health