Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 101YP1600X | Pastoral Counselor | ||
N | 104100000X | Social Worker |
NPI | 1336593458 |
---|---|
Provider Name | Jamal Vann |
First Address | Sicklerville, NJ 08081-1723 |
Second Address | Philadelphia, PA 19132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2016 |
Last Update Date | 14/04/2016 |