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Organization

C-LINE COMMUNITY OUTREACH SERVICES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. CAROLINE NELSON (EXECUTIVE DIRECTOR)
(201) 200-1965
Entity
Organization

Contact information

Practice address
110 MARTIN LUTHER KING JR DR, JERSEY CITY, NJ 07305-3168
(201) 200-1965
(201) 200-1826
Mailing address
PO BOX 15802, JERSEY CITY, NJ 07305-0802
(201) 200-1965
(201) 200-1826

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
37LC00116800
NJ
101YM0800X
Mental Health Counselor
44SC05375200
NJ
261QM1300X
Multi-Specialty Clinic/Center
Primary
2000071
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0352233
NJ
Enumeration date
05/04/2011
Last updated
05/21/2014
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