Provider Demographics
NPI:1629284419
Name:INNOVA COUNSELING AND WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:INNOVA COUNSELING AND WELLNESS CENTER, INC.
Other - Org Name:BETHEL INSTITUTE OF FAMILY SERVICES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CREANGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-427-3255
Mailing Address - Street 1:681 HIGH MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2723
Mailing Address - Country:US
Mailing Address - Phone:973-427-3255
Mailing Address - Fax:
Practice Address - Street 1:681 HIGH MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:NORTH HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-2723
Practice Address - Country:US
Practice Address - Phone:973-427-3255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty