Provider Demographics
NPI:1245375492
Name:FOUNDATION FOR FAMILY GUIDANCE CHRISTIAN COUNSELING CENTER
Entity type:Organization
Organization Name:FOUNDATION FOR FAMILY GUIDANCE CHRISTIAN COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:MSCC
Authorized Official - Phone:856-751-8700
Mailing Address - Street 1:PO BOX 3036
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-0274
Mailing Address - Country:US
Mailing Address - Phone:856-751-8700
Mailing Address - Fax:856-751-3520
Practice Address - Street 1:2003 LINCOLN DR W
Practice Address - Street 2:SUITE A
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1529
Practice Address - Country:US
Practice Address - Phone:856-751-8700
Practice Address - Fax:856-751-3520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100298900103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty