Provider Demographics
NPI:1316366529
Name:BUGGS, DONELL (MA, LAC)
Entity Type:Individual
Prefix:MR
First Name:DONELL
Middle Name:
Last Name:BUGGS
Suffix:
Gender:M
Credentials:MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 US-130, GRANT BUIDING SUITE #408
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077
Mailing Address - Country:US
Mailing Address - Phone:856-310-7332
Mailing Address - Fax:
Practice Address - Street 1:101 US-130, GRANT BUILDING SUITE # 408
Practice Address - Street 2:GRANT BUILDING, SUITE #408
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077
Practice Address - Country:US
Practice Address - Phone:856-389-5458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00618600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional