Provider Demographics
NPI:1003109471
Name:FAMILY HEALTH AND WELLNESS OPPORTUNITY CENTER
Entity type:Organization
Organization Name:FAMILY HEALTH AND WELLNESS OPPORTUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:SR
Authorized Official - Credentials:PHD
Authorized Official - Phone:856-858-5850
Mailing Address - Street 1:200 W HIGH ST STE B
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-2526
Mailing Address - Country:US
Mailing Address - Phone:856-422-9296
Mailing Address - Fax:858-422-9299
Practice Address - Street 1:200 W HIGH ST STE B
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-2526
Practice Address - Country:US
Practice Address - Phone:856-422-9296
Practice Address - Fax:856-422-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty