Organization
PATH FOR CHANGE COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KEIRA HAUCK LCSW (SOLE PROPRIETOR)
(973) 830-6994
Entity
Organization
Contact information
Practice address
88 PARK ST, SUITE 2, MONTCLAIR, NJ 07042-5915
(973) 830-6994
Mailing address
PO BOX 457, MONTCLAIR, NJ 07042-0457
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
44SC05287500
NJ
Other
Enumeration date
12/20/2016
Last updated
12/20/2016
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