Provider Demographics
NPI:1255708822
Name:DATCHI PSYCHOLOGY AND CONSULTING LLC
Entity type:Organization
Organization Name:DATCHI PSYCHOLOGY AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SINGLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORINNE
Authorized Official - Middle Name:CECILE
Authorized Official - Last Name:DATCHI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ABPP
Authorized Official - Phone:812-360-5143
Mailing Address - Street 1:1480 PLEASANT VALLEY WAY
Mailing Address - Street 2:15
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1300
Mailing Address - Country:US
Mailing Address - Phone:812-360-5143
Mailing Address - Fax:
Practice Address - Street 1:35 DEFOREST AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2155
Practice Address - Country:US
Practice Address - Phone:812-360-5143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-30
Last Update Date:2015-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00535000106H00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty