Provider Demographics
NPI:1871027763
Name:JOURNEY COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:JOURNEY COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:HUGO
Authorized Official - Last Name:LLERENA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-320-8130
Mailing Address - Street 1:17 NEWARK BAY CT
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-1904
Mailing Address - Country:US
Mailing Address - Phone:201-320-8130
Mailing Address - Fax:
Practice Address - Street 1:17 NEWARK BAY CT
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-1904
Practice Address - Country:US
Practice Address - Phone:201-320-8130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056687001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty