Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1295187631 |
---|---|
Provider Name | Mr. James Cook |
First Address | Belleville, NJ 07109-1814 |
Second Address | Belleville, NJ 07109-1814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2016 |
Last Update Date | 11/07/2016 |