Provider Demographics
NPI:1447756481
Name:MINCEY, DACOLE
Entity Type:Individual
Prefix:
First Name:DACOLE
Middle Name:
Last Name:MINCEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 TILTON RD REAR
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1214
Mailing Address - Country:US
Mailing Address - Phone:609-484-1133
Mailing Address - Fax:
Practice Address - Street 1:376 TILTON RD REAR
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1214
Practice Address - Country:US
Practice Address - Phone:609-484-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06353300104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker