Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 37LC00292200 | NJ |
NPI | 1003377110 |
---|---|
Provider Name | Mr. Daniel Harris |
First Address | Belleville, NJ 07109-1319 |
Second Address | Belleville, NJ 07109-1319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2019 |
Last Update Date | 29/03/2019 |