Provider Demographics
NPI:1962940270
Name:HOLISTIC BONFIRE LLC
Entity type:Organization
Organization Name:HOLISTIC BONFIRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:SURUCHI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAINI
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NCC, CCTP
Authorized Official - Phone:908-376-9036
Mailing Address - Street 1:571 BUCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-6259
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:258 NEWARK ST
Practice Address - Street 2:SUITE 205
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-3419
Practice Address - Country:US
Practice Address - Phone:908-376-9036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00425500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty