Provider Demographics
NPI:1750616983
Name:CENTER FOR COUNSELING & PERSONAL GROWTH, LLC
Entity type:Organization
Organization Name:CENTER FOR COUNSELING & PERSONAL GROWTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:STANKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:908-307-1842
Mailing Address - Street 1:390 AMWELL RD STE 317
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1246
Mailing Address - Country:US
Mailing Address - Phone:908-307-1842
Mailing Address - Fax:
Practice Address - Street 1:21 E HIGH ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2320
Practice Address - Country:US
Practice Address - Phone:908-307-1842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00385500101YP2500X
NJ35SI00468300103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty