Provider Demographics
NPI:1861244709
Name:CHAIRVILLE COUNSELING
Entity type:Organization
Organization Name:CHAIRVILLE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRIMARY COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:AGNES
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NCC
Authorized Official - Phone:609-388-8919
Mailing Address - Street 1:11 CHAIRVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-9619
Mailing Address - Country:US
Mailing Address - Phone:609-388-8919
Mailing Address - Fax:
Practice Address - Street 1:11 CHAIRVILLE RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-9619
Practice Address - Country:US
Practice Address - Phone:609-388-8919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI-STATE DBT ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty