Provider Demographics
NPI:1639546930
Name:CLEAR CONSCIENCE COUNSELING
Entity Type:Organization
Organization Name:CLEAR CONSCIENCE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCADC
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-454-6711
Mailing Address - Street 1:214 BRENNAN CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-3974
Mailing Address - Country:US
Mailing Address - Phone:973-454-6711
Mailing Address - Fax:
Practice Address - Street 1:214 BRENNAN CT
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-3974
Practice Address - Country:US
Practice Address - Phone:973-454-6711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00233200276400000X, 283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No283Q00000XHospitalsPsychiatric Hospital