Provider Demographics
NPI:1245637578
Name:COUNSELING CENTER AT CLARK, LLC
Entity type:Organization
Organization Name:COUNSELING CENTER AT CLARK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF RCM
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:USILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-318-4400
Mailing Address - Street 1:60 WALNUT AVE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1649
Mailing Address - Country:US
Mailing Address - Phone:732-882-1920
Mailing Address - Fax:732-882-1925
Practice Address - Street 1:60 WALNUT AVE
Practice Address - Street 2:SUITE #201
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1649
Practice Address - Country:US
Practice Address - Phone:732-882-1920
Practice Address - Fax:732-882-1925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2000538261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder