Basic Information
| Provider Information | |||||||||
| NPI: | 1689825077 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COREVALUES CONSULTANTS LLC | ||||||||
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| OtherOrganizationName: | LIFE MATTERS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 HIGHLAND AVE | ||||||||
| Address2: | SUITES C28-29 | ||||||||
| City: | HADDON TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081082634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568543155 | ||||||||
| FaxNumber: | 8568540992 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 HIGHLAND AVE | ||||||||
| Address2: | SUITES C28-29 | ||||||||
| City: | HADDON TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081082634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568543155 | ||||||||
| FaxNumber: | 8568540992 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2008 | ||||||||
| LastUpdateDate: | 10/04/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DUGAN | ||||||||
| AuthorizedOfficialFirstName: | JANICE | ||||||||
| AuthorizedOfficialMiddleName: | STEWART | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8568543155 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PH.D., LPC, LCADC | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | 2000287-07 | NJ | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.