Provider Demographics
NPI:1093772931
Name:TODD, JOHN K (MA, LCADC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:K
Last Name:TODD
Suffix:
Gender:M
Credentials:MA, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S EAST AVE
Mailing Address - Street 2:
Mailing Address - City:WENONAH
Mailing Address - State:NJ
Mailing Address - Zip Code:08090-1919
Mailing Address - Country:US
Mailing Address - Phone:856-464-0662
Mailing Address - Fax:610-497-7244
Practice Address - Street 1:205 S EAST AVE
Practice Address - Street 2:
Practice Address - City:WENONAH
Practice Address - State:NJ
Practice Address - Zip Code:08090-1919
Practice Address - Country:US
Practice Address - Phone:856-464-0662
Practice Address - Fax:610-497-7244
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00085200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)