Provider Demographics
NPI:1942599519
Name:THE CENTER FOR COLLABORATIVE COUNSELING
Entity Type:Organization
Organization Name:THE CENTER FOR COLLABORATIVE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:732-768-3583
Mailing Address - Street 1:PO BOX 1274
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-0230
Mailing Address - Country:US
Mailing Address - Phone:732-768-3583
Mailing Address - Fax:732-534-4360
Practice Address - Street 1:10 ALLEN ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7652
Practice Address - Country:US
Practice Address - Phone:732-768-3583
Practice Address - Fax:732-534-4360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00376700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty