Basic Information
| Provider Information | |||||||||
| NPI: | 1467189563 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WAVES OF CHANGE COUNSELING AND HEALING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 MARSHALL MILL RD | ||||||||
| Address2: | |||||||||
| City: | FRANKLINVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 083222018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6097742907 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 MARSHALL MILL RD | ||||||||
| Address2: | |||||||||
| City: | FRANKLINVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 083222018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6097742907 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2022 | ||||||||
| LastUpdateDate: | 08/08/2022 | ||||||||
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| AuthorizedOfficialLastName: | DAY | ||||||||
| AuthorizedOfficialFirstName: | ALICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 6097742907 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.