Provider Demographics
NPI:1174788715
Name:FULL CIRCLE COUNSELING, LLC
Entity type:Organization
Organization Name:FULL CIRCLE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LSW
Authorized Official - Phone:201-370-6906
Mailing Address - Street 1:63 BEAVERBROOK RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LINCOLN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07035-1440
Mailing Address - Country:US
Mailing Address - Phone:973-694-1950
Mailing Address - Fax:973-694-1952
Practice Address - Street 1:63 BEAVERBROOK RD
Practice Address - Street 2:SUITE 206
Practice Address - City:LINCOLN PARK
Practice Address - State:NJ
Practice Address - Zip Code:07035-1440
Practice Address - Country:US
Practice Address - Phone:973-694-1950
Practice Address - Fax:973-694-1952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC04697500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0161454Medicaid