Provider Demographics
NPI:1912424805
Name:AMERICAN INTERNATIONAL CLINICAL ENTERPRISE
Entity Type:Organization
Organization Name:AMERICAN INTERNATIONAL CLINICAL ENTERPRISE
Other - Org Name:AMEICE INTERNATIONAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDRICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:DARKASHADE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:848-467-1409
Mailing Address - Street 1:610 FOREST VIEW DR
Mailing Address - Street 2:
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-2176
Mailing Address - Country:US
Mailing Address - Phone:848-467-1409
Mailing Address - Fax:
Practice Address - Street 1:50 NORFOLK ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-3228
Practice Address - Country:US
Practice Address - Phone:973-623-3362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ173-040103TA0400X, 251S00000X, 261QM0850X, 261QM0855X, 261QM1102X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM1102XAmbulatory Health Care FacilitiesClinic/CenterMilitary Outpatient Operational (Transportable) Component
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty