Provider Demographics
NPI:1376690347
Name:JAMES, MICHAEL DOUGLAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:JAMES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 NORTH MAPLE AVENUE
Mailing Address - Street 2:SUITE 101C
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450
Mailing Address - Country:US
Mailing Address - Phone:201-606-1694
Mailing Address - Fax:201-962-8218
Practice Address - Street 1:61 NORTH MAPLE AVENUE
Practice Address - Street 2:SUITE 101C
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-606-1694
Practice Address - Fax:201-962-8218
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00069200101YA0400X
NJ37PC00310600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional