Individual
DIANE MOUNTZOURIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCADC, LPC
Contact information
Practice address
510 WHITESVILLE RD, JACKSON, NJ 08527-5044
(732) 766-9016
Mailing address
510 WHITESVILLE RD, JACKSON, NJ 08527-5044
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
37LC00138000
NJ
101YP2500X
Professional Counselor
Primary
37PC00449100
NJ
Other
Enumeration date
06/12/2012
Last updated
06/12/2012
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