Individual
CANDACE ANN BOLTUCH-FAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC;LCADC
Contact information
Practice address
2357 LEMOINE AVE, FORT LEE, NJ 07024
(201) 585-9814
Mailing address
177 COLONIAL RD, EMERSON, NJ 07630-1153
(201) 986-7478
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0551
NJ
Other
Enumeration date
10/03/2006
Last updated
07/08/2007
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