Provider Demographics
NPI:1982000741
Name:ACINA BEHAVIORAL HEALTH SOLUTIONS LLC
Entity Type:Organization
Organization Name:ACINA BEHAVIORAL HEALTH SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYREASEA
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON-MASON
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:609-350-4792
Mailing Address - Street 1:59 GRANT LN
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-9469
Mailing Address - Country:US
Mailing Address - Phone:609-350-4792
Mailing Address - Fax:
Practice Address - Street 1:618 S WHITE HORSE PIKE FL 1
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:NJ
Practice Address - Zip Code:08106-1315
Practice Address - Country:US
Practice Address - Phone:609-350-4792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00429100363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty