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Individual

JAMES T SOUTHARD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LSW

Contact information

Practice address
218A SUNSET RD, SCREENING CRISIS & INTERVENTION PROGRAM, WILLINGBORO, NJ 08046-1110
(609) 835-6180
(609) 835-7962
Mailing address
1289 ROUTE 38, HAINESPORT, NJ 08036-2730
(609) 267-5656

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
NONE
104100000X
Social Worker
Primary
44SL05150000
NJ
174400000X
Specialist
S-2219
NJ

Other

Enumeration date
04/21/2009
Last updated
04/21/2009
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