Organization
BACK ON TRACK COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MUSTAFA SHAKIR ABDUS-SALAAM MHS-C,LPC, LCADC (CEO)
(862) 217-5144
Entity
Organization
Contact information
Practice address
19 ORANGE PL, IRVINGTON, NJ 07111-2019
(973) 474-8441
Mailing address
19 ORANGE PL, IRVINGTON, NJ 07111-2019
(973) 474-8441
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
07/27/2019
Last updated
07/27/2019
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