Provider Demographics
NPI:1619305927
Name:MENDOZA, DONALD D (NCC, LPC, LCADC)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:D
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:NCC, LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-4832
Mailing Address - Country:US
Mailing Address - Phone:201-370-8713
Mailing Address - Fax:
Practice Address - Street 1:61 COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-4832
Practice Address - Country:US
Practice Address - Phone:201-370-8713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2014-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00201200101YA0400X
NJ37PC00432200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)