Provider Demographics
NPI:1023760816
Name:CHAMOMILE COUNSELING LLC
Entity type:Organization
Organization Name:CHAMOMILE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHI EON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:551-486-8239
Mailing Address - Street 1:19 E HARWOOD TER UNIT A
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1424
Mailing Address - Country:US
Mailing Address - Phone:551-486-8239
Mailing Address - Fax:
Practice Address - Street 1:19 E HARWOOD TER UNIT A
Practice Address - Street 2:
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-1424
Practice Address - Country:US
Practice Address - Phone:551-486-8239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-22
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty