Provider Demographics
NPI:1023522588
Name:COUNSELING AND WELLNESS INSTITUTE
Entity type:Organization
Organization Name:COUNSELING AND WELLNESS INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:ECONOMOU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:866-369-1090
Mailing Address - Street 1:450 7TH ST STE LL5
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-2079
Mailing Address - Country:US
Mailing Address - Phone:866-369-1090
Mailing Address - Fax:866-369-2140
Practice Address - Street 1:450 7TH ST.
Practice Address - Street 2:LL5
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030
Practice Address - Country:US
Practice Address - Phone:866-369-1090
Practice Address - Fax:866-369-2140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & SportsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1578883146Medicaid