Provider Demographics
NPI:1043949514
Name:KJEMS, COLLEEN (LCADC, CCS, NCAC1, I)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:
Last Name:KJEMS
Suffix:
Gender:F
Credentials:LCADC, CCS, NCAC1, I
Other - Prefix:MS
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:KJEMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCADC, CCS, NCAC1, I
Mailing Address - Street 1:28 FOX ST
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-3612
Mailing Address - Country:US
Mailing Address - Phone:848-469-0531
Mailing Address - Fax:
Practice Address - Street 1:615 HOPE RD STE 5B5A&4A
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-1277
Practice Address - Country:US
Practice Address - Phone:732-858-5432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00090000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)