Provider Demographics
NPI:1245854272
Name:CHAMPION PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:CHAMPION PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LCADC
Authorized Official - Phone:609-638-7560
Mailing Address - Street 1:P.O. BOX 2623
Mailing Address - Street 2:
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-9998
Mailing Address - Country:US
Mailing Address - Phone:609-638-7560
Mailing Address - Fax:
Practice Address - Street 1:17 BRADFORD AVE APT 13
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08610-3107
Practice Address - Country:US
Practice Address - Phone:609-638-7560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty