Healthcare Provider Details

I. General information

NPI: 1508034455
Provider Name (Legal Business Name): GARY A DOCK SR. LCADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 HIGHLAND AVE STE C
HADDON TOWNSHIP NJ
08108-2634
US

IV. Provider business mailing address

215 HIGHLAND AVE STE C STE C
HADDON TOWNSHIP NJ
08108-2634
US

V. Phone/Fax

Practice location:
  • Phone: 862-324-4375
  • Fax:
Mailing address:
  • Phone: 862-324-4375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC000761000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: