Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YP2500X | Professional Counselor | 37PC00423800 | NJ |
NPI | 1003040312 |
---|---|
Provider Name | James W Fay IV |
First Address | Washington, NJ 07882-1213 |
Second Address | Bridgewater, NJ 08807-2949 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2009 |
Last Update Date | 19/07/2011 |