Provider Demographics
NPI:1336665140
Name:PSYCHOLOGICAL & HOLISTIC HEALING CENTER LLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL & HOLISTIC HEALING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:TABONE
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D, MSW
Authorized Official - Phone:609-408-0818
Mailing Address - Street 1:PO BOX 565
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:NJ
Mailing Address - Zip Code:08270-0565
Mailing Address - Country:US
Mailing Address - Phone:609-408-0818
Mailing Address - Fax:
Practice Address - Street 1:185 PETERSBURG RD
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:NJ
Practice Address - Zip Code:08270-9439
Practice Address - Country:US
Practice Address - Phone:609-408-0818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00500500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty