Provider Demographics
NPI:1639552714
Name:GORRELL, CHARDE ALANA
Entity Type:Individual
Prefix:MS
First Name:CHARDE
Middle Name:ALANA
Last Name:GORRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 WOODLANE RD STE 35
Mailing Address - Street 2:
Mailing Address - City:WESTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-3803
Mailing Address - Country:US
Mailing Address - Phone:732-693-5189
Mailing Address - Fax:
Practice Address - Street 1:770 WOODLANE RD STE 35
Practice Address - Street 2:
Practice Address - City:WESTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060-3803
Practice Address - Country:US
Practice Address - Phone:732-693-5189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00155000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health