Provider Demographics
NPI:1124665708
Name:SUPPLANTER COUNSELING & MEDIATION, LLC
Entity type:Organization
Organization Name:SUPPLANTER COUNSELING & MEDIATION, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:PORTER- STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:LCADC, LCSW, SAP
Authorized Official - Phone:609-454-3080
Mailing Address - Street 1:1330 PARKWAY AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-3006
Mailing Address - Country:US
Mailing Address - Phone:609-454-3080
Mailing Address - Fax:609-454-3078
Practice Address - Street 1:1330 PARKWAY AVE STE 7
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-3006
Practice Address - Country:US
Practice Address - Phone:609-454-3080
Practice Address - Fax:609-454-3078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-03
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty