Provider Demographics
NPI:1962844415
Name:FAITH CHRISTIAN COUNSELING CENTER INC
Entity Type:Organization
Organization Name:FAITH CHRISTIAN COUNSELING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:III
Authorized Official - Credentials:M TH
Authorized Official - Phone:609-880-3025
Mailing Address - Street 1:39 SOMERSET DR
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-1433
Mailing Address - Country:US
Mailing Address - Phone:609-880-3025
Mailing Address - Fax:
Practice Address - Street 1:704 COOPER ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:NJ
Practice Address - Zip Code:08010-1702
Practice Address - Country:US
Practice Address - Phone:609-880-3025
Practice Address - Fax:888-397-1415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052214001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty