| Champion Psychological Services, Llc | |
|
17 Bradford Ave Apt 13 Trenton NJ 08610-3107 | |
| (609) 638-7560 | |
| Not Available |
| Full Name | Champion Psychological Services, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 17 Bradford Ave Apt 13, Trenton, New Jersey |
| Authorized Official Name and Position | Carmen Lynn Hodges (OWNER) |
| Authorized Official Contact | 6096387560 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Champion Psychological Services, Llc P.o. Box 2623 Mercerville NJ 08619-9998 Ph: (609) 638-7560 | Champion Psychological Services, Llc 17 Bradford Ave Apt 13 Trenton NJ 08610-3107 Ph: (609) 638-7560 |
| NPI Number | 1245854272 |
|---|---|
| Provider Enumeration Date | 06/05/2020 |
| Last Update Date | 06/05/2020 |
| Certification Date | 06/05/2020 |
| Medicare PECOS PAC ID | 4981026879 |
|---|---|
| Medicare Enrollment ID | O20200623001337 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245854272 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Carmen L Hodges |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1275967762 PECOS PAC ID: 4789909862 Enrollment ID: I20150212000770 |
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