Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 37LC00097900 | NJ |
NPI | 1003252628 |
---|---|
Provider Name | Christine Hoff Lysiak |
First Address | Somerville, NJ 08876-1911 |
Second Address | Somerville, NJ 08876-1911 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2013 |
Last Update Date | 22/05/2013 |