Basic Information
Provider Information | |||||||||
NPI: | 1548793102 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ASPIRE TO ACHIEVE COUNSELING SERVICES, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 215 HIGHLAND AVE STE C | ||||||||
Address2: |   | ||||||||
City: | HADDON TOWNSHIP | ||||||||
State: | NJ | ||||||||
PostalCode: | 081082634 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8562540828 | ||||||||
FaxNumber: | 8568540992 | ||||||||
Practice Location | |||||||||
Address1: | 215 HIGHLAND AVE STE C | ||||||||
Address2: |   | ||||||||
City: | HADDON TOWNSHIP | ||||||||
State: | NJ | ||||||||
PostalCode: | 081082634 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8562540828 | ||||||||
FaxNumber: | 8562540828 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/10/2017 | ||||||||
LastUpdateDate: | 03/24/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BRITT-MEADOWS | ||||||||
AuthorizedOfficialFirstName: | JANICE | ||||||||
AuthorizedOfficialMiddleName: | S | ||||||||
AuthorizedOfficialTitleorPosition: | EXEC. DIR./OWNER/SOLE MEMBER | ||||||||
AuthorizedOfficialTelephone: | 8562540828 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MSW, LCSW | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 305S00000X | 44SC0445536200 | NJ | N |   | Managed Care Organizations | Point of Service |   | 251S00000X | 44SC0445536200 | NJ | Y |   | Agencies | Community/Behavioral Health |   |
ID Information
ID | Type | State | Issuer | Description | 424681ZHYF | 01 | NJ | 82551 ENROLLMENT TYPE | OTHER |