Provider Demographics
NPI:1962939793
Name:CHANGE AND GROWTH COUNCELING LLC
Entity type:Organization
Organization Name:CHANGE AND GROWTH COUNCELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BATIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRETZKY DRUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-841-4666
Mailing Address - Street 1:195 BUCKINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-4927
Mailing Address - Country:US
Mailing Address - Phone:732-841-4666
Mailing Address - Fax:
Practice Address - Street 1:195 BUCKINGHAM WAY
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-4927
Practice Address - Country:US
Practice Address - Phone:732-841-4666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05549900251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health