Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 37LC00165700 | NJ |
NPI | 1003399593 |
---|---|
Provider Name | Mrs. Kelly Efchak |
First Address | Lake Hopatcong, NJ 07849-2219 |
Second Address | Newton, NJ 07860-2773 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2018 |
Last Update Date | 11/09/2018 |