Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 37LC00096800 | NJ |
Y | 101YP2500X | Professional Counselor | 37PC00049100 | NJ |
NPI | 1003041401 |
---|---|
Provider Name | Jennifer Lynn Douglas-Kruk |
First Address | Denville, NJ 07834-1735 |
Second Address | Denville, NJ 07834-1735 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2009 |
Last Update Date | 29/05/2009 |