Provider Demographics
NPI:1750692224
Name:ECCKLES, SANIETRA (BA)
Entity type:Individual
Prefix:MS
First Name:SANIETRA
Middle Name:
Last Name:ECCKLES
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HONEY LOCUST LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-4346
Mailing Address - Country:US
Mailing Address - Phone:609-954-6326
Mailing Address - Fax:
Practice Address - Street 1:218A SUNSET RD
Practice Address - Street 2:SCREENING, CRISIS, & INTERVENTION (SCIP)
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1110
Practice Address - Country:US
Practice Address - Phone:609-835-6180
Practice Address - Fax:609-835-7962
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist