Provider Demographics
NPI:1326769845
Name:DORAN, ANTHONY THOMAS III (LCADC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:THOMAS
Last Name:DORAN
Suffix:III
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 FERGUSON ST
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1403
Mailing Address - Country:US
Mailing Address - Phone:908-319-5971
Mailing Address - Fax:
Practice Address - Street 1:121 SHELLEY DR STE 2E
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2530
Practice Address - Country:US
Practice Address - Phone:908-319-5971
Practice Address - Fax:908-979-1600
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00354900101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)