Provider Demographics
NPI:1124420302
Name:KEDESH COUNSLING CENTER
Entity type:Organization
Organization Name:KEDESH COUNSLING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ABBEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MSLPC,ACS
Authorized Official - Phone:856-696-5690
Mailing Address - Street 1:2630 E CHESTNUT AVE
Mailing Address - Street 2:SUITE D-4
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-8400
Mailing Address - Country:US
Mailing Address - Phone:856-696-4380
Mailing Address - Fax:856-696-0974
Practice Address - Street 1:2725 N DELSEA DR
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-2184
Practice Address - Country:US
Practice Address - Phone:856-696-4380
Practice Address - Fax:856-696-0974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty