Organization
JOURNEY FULFILLED LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL ANN EVANS (OWNER)
(908) 350-8643
Entity
Organization
Contact information
Practice address
1390 VALLEY RD STE 1B, STIRLING, NJ 07980-1346
(908) 350-8643
(908) 350-8644
Mailing address
1390 VALLEY RD STE 1B, STIRLING, NJ 07980-1346
(908) 350-8643
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44SC05796600
LCSW
NJ
Enumeration date
12/16/2018
Last updated
12/16/2018
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