Provider Demographics
NPI:1457077646
Name:FEATHERLIGHT COUNSELING AND CONSULTATION LLC
Entity Type:Organization
Organization Name:FEATHERLIGHT COUNSELING AND CONSULTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:PROVANCE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:908-510-0532
Mailing Address - Street 1:807 CRANBURY CROSS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-2268
Mailing Address - Country:US
Mailing Address - Phone:908-510-0532
Mailing Address - Fax:
Practice Address - Street 1:807 CRANBURY CROSS RD
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-2268
Practice Address - Country:US
Practice Address - Phone:908-510-0532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-18
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health