Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 37LC00216000 | NJ |
Y | 101YP2500X | Professional Counselor | 37PC00499400 | NJ |
NPI | 1003218082 |
---|---|
Provider Name | Mr. Ariel Lippa, |
First Address | Newark, NJ 07103-2496 |
Second Address | Newark, NJ 07103-2496 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2014 |
Last Update Date | 11/08/2016 |