Provider Demographics
NPI:1457535833
Name:ACKLEY, GEORGE WALTON (PHD, PC)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:WALTON
Last Name:ACKLEY
Suffix:
Gender:M
Credentials:PHD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-0339
Mailing Address - Country:US
Mailing Address - Phone:609-675-0872
Mailing Address - Fax:609-886-8426
Practice Address - Street 1:2848 S DELSEA DR
Practice Address - Street 2:BLDG. B
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-7042
Practice Address - Country:US
Practice Address - Phone:609-675-0872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00302800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7158700Medicaid
NJ7158700Medicaid