MEDICARE: COLLEEN DEVLIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1174980114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN DEVLIN

Provider Business Mailing Address
First Line	:	114 CLEVELAND AVE
Second Line	:
City	:	MOUNT EPHRAIM
State	:	NJ
Zip	:	08059-1405
Country	:	US
Telephone Number	:	609-458-3593
Fax Number	:

Provider Business Practice Location Address
First Line	:	526 S BURNT MILL RD
Second Line	:
City	:	VOORHEES
State	:	NJ
Zip	:	08043-2205
Country	:	US
Telephone Number	:	856-216-6003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2016
Last Update Date	:	05/13/2019

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