Provider Demographics
NPI:1821857426
Name:EVEXIA COUNSELING & ADVOCACY SERVICE LLC
Entity Type:Organization
Organization Name:EVEXIA COUNSELING & ADVOCACY SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-966-9023
Mailing Address - Street 1:155 WILLOWBROOK BLVD
Mailing Address - Street 2:STE 110 #5451
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470
Mailing Address - Country:US
Mailing Address - Phone:201-966-9023
Mailing Address - Fax:
Practice Address - Street 1:118 OGDEN AVENUE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-1307
Practice Address - Country:US
Practice Address - Phone:201-966-9023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty