| Organization Name: | COUNSELING CENTER AT CLARK, LLC |
| NPI Number: | 1245637578 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LINDA ROSE BURNS (CHIEF NSG AND LICENSING OFFICER) |
| Mailing Address: | 60 Walnut Ave Suite #201 Clark |
| State: | NJ US |
| Postal Code: | 070661649 |
| Phone Number: | 7328821920 |
| Fax Number: | 7328821925 |
| NPI Enumeration Date: | 12/02/2014 |
| NPI Last Update Date: | 12/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0405X |
| License Number: | 2000538 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
| Taxonomy Definition: | |