Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | #37LC00133700 | NJ |
Y | 101YM0800X | Mental Health Counselor | #37LC00133700 | NJ |
NPI | 1003087800 |
---|---|
Provider Name | Madeline Thompson |
First Address | Pompton Plains, NJ 07444-1047 |
Second Address | Highland Lakes, NJ 07422-1605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2008 |
Last Update Date | 19/03/2008 |