Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 37LC00268200 | NJ |
N | 101YP1600X | Pastoral Counselor | 042017 | NJ |
Y | 101YP2500X | Professional Counselor | 37PC00597000 | NJ |
N | 101YS0200X | School Counselor | 660095 | NJ |
NPI | 1285146647 |
---|---|
Provider Name | Jeffrie Popplewell |
First Address | Cliffside Park, NJ 07010-2183 |
Second Address | Lebanon, NJ 08833-3106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2017 |
Last Update Date | 23/10/2018 |