Organization
CFG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERI BLACK LPC (DIRECTOR)
(856) 575-4196
Entity
Organization
Contact information
Practice address
333 IRVING AVE, BRIDGETON, NJ 08302-2123
(856) 575-4196
Mailing address
333 IRVING AVE, BRIDGETON, NJ 08302-2123
(856) 575-4196
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
03/12/2015
Last updated
03/12/2015
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