Provider Demographics
NPI:1770368243
Name:INSTITUTE FOR RELATIONAL WELLNESS LLC
Entity type:Organization
Organization Name:INSTITUTE FOR RELATIONAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-357-4148
Mailing Address - Street 1:18 IPSWICH PL
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2316
Mailing Address - Country:US
Mailing Address - Phone:856-357-4148
Mailing Address - Fax:
Practice Address - Street 1:20 BRACE RD STE 202
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2634
Practice Address - Country:US
Practice Address - Phone:856-357-4148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty