Organization
SURFSIDE RECOVERY SERVICES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IAN L. KOCH MS, LCADC, CAS (EXECUTIVE DIRECTOR)
(609) 709-0244
Entity
Organization
Contact information
Practice address
3 S WEYMOUTH AVE, VENTNOR CITY, NJ 08406-2980
(609) 709-0245
Mailing address
3 EDGEWOOD DR, SOMERS POINT, NJ 08244-1613
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
37LC00214900
NJ
101YP2500X
Professional Counselor
Primary
37PC00513700
NJ
Other
Enumeration date
12/31/2017
Last updated
12/31/2017
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