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Individual

NICHOLAS STAFFORD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CPRS

Contact information

Practice address
610 PEMBERTON BROWNS MILLS RD, PEMBERTON, NJ 08068-1537
(609) 321-6269
(609) 283-0262
Mailing address
610 PEMBERTON BROWNS MILLS RD, PEMBERTON, NJ 08068-1537
(609) 321-6269

Taxonomy

Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
1000140
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1000140
SUBSTANCE ABUSE REHABILITATION FACILITY
NJ
Enumeration date
11/10/2022
Last updated
11/10/2022
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