Organization
FAMILY THERAPY AND CONSULTATION SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY KLINE GOLD LPC (PRESIDENT)
(856) 332-4698
Entity
Organization
Contact information
Practice address
1 LUPTON AVE, WOODBURY, NJ 08096-5901
(856) 332-4698
(856) 415-7574
Mailing address
1 LUPTON AVE, WOODBURY, NJ 08096-5901
(856) 693-5775
(856) 415-7574
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
0400067046
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0046132
PROVIDER NUMBER
NJ
01
—
6P2422
MEDICARE
NJ
Enumeration date
01/12/2007
Last updated
06/21/2024
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