Organization
ICBH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLARISSA MULLIGAN ATTARA PHD, LPC, LCADC, ACS (COUNSELOR, SUPERVISOR, EDUCATOR)
(732) 668-4460
Entity
Organization
Contact information
Practice address
130 MAPLE AVE STE WB2, RED BANK, NJ 07701-1736
(732) 668-4460
Mailing address
200 VILLAGE CENTER DR, # 6722, FREEHOLD, NJ 07728-1702
(732) 668-4460
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0450874979
0450874979
NJ
Enumeration date
12/20/2022
Last updated
12/12/2023
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