Provider Demographics
NPI:1366197303
Name:GLORIOUS DAWN MENTAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:GLORIOUS DAWN MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:UZONWANNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-215-8536
Mailing Address - Street 1:540 NORTH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7149
Mailing Address - Country:US
Mailing Address - Phone:201-470-6198
Mailing Address - Fax:201-630-8916
Practice Address - Street 1:540 NORTH AVE STE 3
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7149
Practice Address - Country:US
Practice Address - Phone:201-470-6198
Practice Address - Fax:201-630-8916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-17
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)