Organization
CHILDRENS INTENSIVE IN COMMUNITY PROGRAM
Active
Organization
CHILDRENS INTENSIVE IN COMMUNITY PROGRAM
Active
Other names
Non Profit Organization
Organization subpart
No
Provider details
NPI number
Authorized official
MOMAH G COOPER (EXECUTIVE DIRECTOR)
(856) 829-9440
Entity
Organization
Contact information
Practice address
101 RT 130 S, GRANT BUILDING SUITE 440, CINNAMINSON, NJ 08077-2845
(856) 829-9440
Mailing address
101 RT 130 S, GRANT BUILDING SUITE 440, CINNAMINSON, NJ 08077-2845
(856) 829-9440
(856) 829-9444
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
PC003757
PA
1041C0700X
Clinical Social Worker
Primary
445L05145400
NJ
Other
Enumeration date
08/05/2007
Last updated
08/05/2007
Update your record
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