Provider Demographics
NPI:1770957086
Name:WISE PATH COUNSELING
Entity type:Organization
Organization Name:WISE PATH COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:385-313-0680
Mailing Address - Street 1:11 W ORMOND AVE
Mailing Address - Street 2:STE 200-D
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-3054
Mailing Address - Country:US
Mailing Address - Phone:385-313-0680
Mailing Address - Fax:
Practice Address - Street 1:11 W ORMOND AVE
Practice Address - Street 2:STE 200-D
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3054
Practice Address - Country:US
Practice Address - Phone:385-313-0680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05656600251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health