Organization
COMMUNITOPIA
Active
Organization
COMMUNITOPIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KHADIJAH ISMAEL (BOARD OF DIRECTOR)
(973) 979-6144
Entity
Organization
Contact information
Practice address
2101 LINCOLN HWY, EDISON, NJ 08817-3329
(973) 979-6144
Mailing address
2101 LINCOLN HWY, 404, EDISON, NJ 08817-3329
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
44SC00856100
NJ
101Y00000X
Counselor
44SL06046000
NJ
101YA0400X
Addiction (Substance Use Disorder) Counselor
44SC00856100
NJ
101YA0400X
Addiction (Substance Use Disorder) Counselor
44SL06046000
NJ
101YM0800X
Mental Health Counselor
44SC00856100
NJ
103K00000X
Behavior Analyst
44SC00856100
NJ
103K00000X
Behavior Analyst
44SL06046000
NJ
1041C0700X
Clinical Social Worker
Primary
44SC00856100
NJ
1041C0700X
Clinical Social Worker
44SL06046000
NJ
Other
Enumeration date
04/18/2016
Last updated
04/18/2016
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