Provider Demographics
NPI:1790414795
Name:DALLAS, CELESTINA E (MS, CPRS)
Entity Type:Individual
Prefix:
First Name:CELESTINA
Middle Name:E
Last Name:DALLAS
Suffix:
Gender:F
Credentials:MS, CPRS
Other - Prefix:
Other - First Name:CELESTINA
Other - Middle Name:E
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 AMERICAN BLVD
Mailing Address - Street 2:
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-1767
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 AMERICAN BLVD STE 5
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-1767
Practice Address - Country:US
Practice Address - Phone:856-352-5999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)