Provider Demographics
NPI:1013441567
Name:OUR GARDEN OF HEALING COUNSELING
Entity Type:Organization
Organization Name:OUR GARDEN OF HEALING COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BERTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-223-1676
Mailing Address - Street 1:340 STUYVESANT AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-1640
Mailing Address - Country:US
Mailing Address - Phone:973-223-1676
Mailing Address - Fax:973-223-1676
Practice Address - Street 1:340 STUYVESANT AVE APT 3
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-1640
Practice Address - Country:US
Practice Address - Phone:973-223-1676
Practice Address - Fax:973-223-1676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health