Provider Demographics
NPI:1043533151
Name:FORD, DAVID JULIUS JR (LCMHC, LPC, NCC, ACS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JULIUS
Last Name:FORD
Suffix:JR
Gender:M
Credentials:LCMHC, LPC, NCC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WILLOW DR APT 2A
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-2832
Mailing Address - Country:US
Mailing Address - Phone:336-340-7602
Mailing Address - Fax:
Practice Address - Street 1:87 MAPLE AVE STE 2
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1761
Practice Address - Country:US
Practice Address - Phone:336-340-7602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006314101YP2500X
NJ37PC00659900101YP2500X
NC9034101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health