| Supportive Space Counseling Center | |
|
1320 Outlook Dr Mountainside NJ 07092-1411 | |
| (609) 429-4451 | |
| Not Available |
| Full Name | Supportive Space Counseling Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1320 Outlook Dr, Mountainside, New Jersey |
| Authorized Official Name and Position | Lindsay A Scholz (OWNER/CLINICAL DIRECTOR) |
| Authorized Official Contact | 6094294451 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Supportive Space Counseling Center Po Box 2244 Flemington NJ 08822-2244 Ph: (908) 313-9484 | Supportive Space Counseling Center 1320 Outlook Dr Mountainside NJ 07092-1411 Ph: (609) 429-4451 |
| NPI Number | 1093337396 |
|---|---|
| Provider Enumeration Date | 05/11/2020 |
| Last Update Date | 05/11/2020 |
| Certification Date | 05/11/2020 |
| Medicare PECOS PAC ID | 2466859392 |
|---|---|
| Medicare Enrollment ID | O20210922000022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093337396 | NPI | - | NPPES |
| Provider Name | Dana Green-witter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588877070 PECOS PAC ID: 7719384551 Enrollment ID: I20210922000694 |
| Provider Name | Lindsay A Scholz |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1245775964 PECOS PAC ID: 3375940208 Enrollment ID: I20240207001572 |
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