Provider Demographics
NPI:1891561098
Name:ENTREKIN, MICHAEL (NCC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ENTREKIN
Suffix:
Gender:M
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 PHYLLIS DR
Mailing Address - Street 2:
Mailing Address - City:GIBBSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08027-1670
Mailing Address - Country:US
Mailing Address - Phone:609-678-8222
Mailing Address - Fax:
Practice Address - Street 1:199 PHYLLIS DR
Practice Address - Street 2:
Practice Address - City:GIBBSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08027-1670
Practice Address - Country:US
Practice Address - Phone:609-678-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ01604819101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool