Provider Demographics
NPI:1699266353
Name:PROGRESS AND GROWTH COUNSELING SERVICES
Entity type:Organization
Organization Name:PROGRESS AND GROWTH COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:NINO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:856-981-5480
Mailing Address - Street 1:16 CHURCHILL WAY
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2427
Mailing Address - Country:US
Mailing Address - Phone:856-981-5480
Mailing Address - Fax:
Practice Address - Street 1:701 S ROUTE 73 STE F
Practice Address - Street 2:
Practice Address - City:WEST BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08091-2603
Practice Address - Country:US
Practice Address - Phone:856-981-5480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054071001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty