Individual
IAN KOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LCADC, CAS
Contact information
Practice address
3 S WEYMOUTH AVE UNIT G, 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
Primary
37LC00214900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
OTHER
—
Enumeration date
12/29/2017
Last updated
12/29/2017
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