| Organization Name: | AXIS I PROFESSIONAL SERVICES, LLC |
| NPI Number: | 1235526872 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HELEN V HICKS (OWNER) |
| Mailing Address: | 101 Route 130 S Ste #325 Cinnaminson |
| State: | NJ US |
| Postal Code: | 080772845 |
| Phone Number: | 8665193401 |
| Fax Number: | 8662885024 |
| NPI Enumeration Date: | 04/21/2015 |
| NPI Last Update Date: | 04/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 37PC00387400 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |