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151 S Durand Pl Irvington NJ 07111-1807 | |
| (973) 704-1200 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 151 S Durand Pl, Irvington, New Jersey |
| Authorized Official Name and Position | Corey T Wilson (FOUNDER/CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 9737041200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
151 S Durand Pl Irvington NJ 07111-1807 Ph: (973) 704-1200 | 151 S Durand Pl Irvington NJ 07111-1807 Ph: (973) 704-1200 |
| NPI Number | 1992985188 |
|---|---|
| Provider Enumeration Date | 11/06/2007 |
| Last Update Date | 11/06/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992985188 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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