Provider Demographics
NPI:1366829079
Name:CENTER FOR COUNSELING AND MINDFUL LIVING, LLC
Entity type:Organization
Organization Name:CENTER FOR COUNSELING AND MINDFUL LIVING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHAFOS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:908-516-8422
Mailing Address - Street 1:P.O. BOX 629
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08542-0629
Mailing Address - Country:US
Mailing Address - Phone:908-516-8422
Mailing Address - Fax:
Practice Address - Street 1:257 US HIGHWAY 22
Practice Address - Street 2:SUITE B
Practice Address - City:GREEN BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08812-1807
Practice Address - Country:US
Practice Address - Phone:908-516-8422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP2500X, 103T00000X
NJ37PC00515300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty