Doctor Name: | INDIA CASSELL |
NPI Number: | 1073998902 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | C07663627353952 |
Business Practice Address: | 16 Lancelot Ln Mount Laurel, NJ - 080541913 |
Business Phone Number: | 6098363279 |
Business Fax Number: | |
Mailing Address: | 16 Lancelot Ln, MOUNT LAUREL |
State: | NJ |
Postal Code: | 080541913 |
Phone Number: | 6098363279 |
Fax Number: | |
NPI Enumeration Date: | 07/21/2015 |
NPI Last Update Date: | 07/21/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | C07663627353952 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |