Provider Demographics
NPI:1972853034
Name:URBAN LIFE COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:URBAN LIFE COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:MA, LPC, LCADC, CCS
Authorized Official - Phone:973-677-7053
Mailing Address - Street 1:220 S HARRISON ST
Mailing Address - Street 2:SUITE A.
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1401
Mailing Address - Country:US
Mailing Address - Phone:973-677-7053
Mailing Address - Fax:973-677-7050
Practice Address - Street 1:220 S HARRISON ST
Practice Address - Street 2:SUITE A.
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1401
Practice Address - Country:US
Practice Address - Phone:973-677-7053
Practice Address - Fax:973-677-7050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2000036-04261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health