Provider Demographics
NPI:1558778209
Name:WAYNE MAGEE LCADC
Entity Type:Organization
Organization Name:WAYNE MAGEE LCADC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABUSE COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGEE
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCADC
Authorized Official - Phone:856-332-0290
Mailing Address - Street 1:35 S BURLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-2262
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1665 NORTH AVE
Practice Address - Street 2:
Practice Address - City:PORT NORRIS
Practice Address - State:NJ
Practice Address - Zip Code:08349
Practice Address - Country:US
Practice Address - Phone:856-332-0290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00205500101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5312960OtherAETNA