Individual
JONATHAN DAVID DOUGLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LAC
Contact information
Practice address
1750 ZION RD STE 209, NORTHFIELD, NJ 08225-1844
(609) 204-6134
(570) 864-3353
Mailing address
1750 ZION RD STE 209, NORTHFIELD, NJ 08225-1844
(609) 204-6134
(570) 864-3353
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
37AC00141100
NJ
101YP2500X
Professional Counselor
Primary
37AC00141100
NJ
106H00000X
Marriage & Family Therapist
37AC00141100
NJ
Other
Enumeration date
11/18/2012
Last updated
11/18/2012
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