Provider Demographics
NPI:1912101155
Name:FAITH CHRISTIAN COUNSELING CENTER INC
Entity type:Organization
Organization Name:FAITH CHRISTIAN COUNSELING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:609-346-0619
Mailing Address - Street 1:39 SOMERSET DR
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-1433
Mailing Address - Country:US
Mailing Address - Phone:608-346-0619
Mailing Address - Fax:888-201-7278
Practice Address - Street 1:215 LOCUST ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:NJ
Practice Address - Zip Code:08010
Practice Address - Country:US
Practice Address - Phone:609-877-4411
Practice Address - Fax:888-201-7278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00576900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty