Provider Demographics
NPI:1063846582
Name:AVELLA, JOHN D (LPC NCC NJSP DRCC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:AVELLA
Suffix:
Gender:M
Credentials:LPC NCC NJSP DRCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 BRICK BLVD
Mailing Address - Street 2:SUITE 206B
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-7984
Mailing Address - Country:US
Mailing Address - Phone:732-477-0862
Mailing Address - Fax:732-477-0879
Practice Address - Street 1:74 BRICK BLVD
Practice Address - Street 2:SUITE 206B
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-7984
Practice Address - Country:US
Practice Address - Phone:732-477-0862
Practice Address - Fax:732-477-0879
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00152000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional