Provider Demographics
NPI:1881026151
Name:THE CENTER FOR COUNSELING AND HOLISTIC SERVICES
Entity Type:Organization
Organization Name:THE CENTER FOR COUNSELING AND HOLISTIC SERVICES
Other - Org Name:NJ CCHS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDING EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VASHONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ETIENNE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-491-6060
Mailing Address - Street 1:2410 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-4004
Mailing Address - Country:US
Mailing Address - Phone:201-491-6060
Mailing Address - Fax:201-346-4365
Practice Address - Street 1:271 ROUTE 46 W
Practice Address - Street 2:C-110
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-2440
Practice Address - Country:US
Practice Address - Phone:201-491-6060
Practice Address - Fax:201-346-4365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05537800251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health