Amelo Bacchus, LAC
Counselor, Mental Health in East Orange, NJ. Individual provider (NPI-1).
NPI number1205656402
StatusActive
Last updated in NPPESOct 12, 2024
Details
- NPI
- 1205656402
- Entity type
- Individual (NPI-1)
- Name
- Amelo Bacchus
- Credential
- LAC
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Oct 12, 2024
- Certification date
- Oct 12, 2024
- Last updated
- Oct 12, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YM0800X | Counselor, Mental Health | 37AC00826000 | NJ | Yes |
Practice location
67 Sanford StEast Orange, NJ 07018-1926
Phone 973-673-3342 · Fax 973-673-5612
Mailing address
54 Polk St Apt O3Newark, NJ 07105-2880
Phone 862-218-7755
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