Provider Demographics
NPI:1992187769
Name:CHRISTIAN COUNSELING CENTER OF NY & NJ, LLC
Entity Type:Organization
Organization Name:CHRISTIAN COUNSELING CENTER OF NY & NJ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGSTOL
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:201-661-4372
Mailing Address - Street 1:19 SPEAR RD.
Mailing Address - Street 2:SUITE #205
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446
Mailing Address - Country:US
Mailing Address - Phone:201-818-1234
Mailing Address - Fax:
Practice Address - Street 1:19 SPEAR RD.
Practice Address - Street 2:SUITE #205
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446
Practice Address - Country:US
Practice Address - Phone:201-818-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00262200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty