Healthcare Provider Details

I. General information

NPI: 1033073572
Provider Name (Legal Business Name): JAMES PAYNE LAC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MIDDLESEX ESSEX TPKE STE 102
ISELIN NJ
08830-2033
US

IV. Provider business mailing address

14 BASHFORD AVENUE APT. F
UNION NJ
07083
US

V. Phone/Fax

Practice location:
  • Phone: 732-844-8318
  • Fax:
Mailing address:
  • Phone: 973-979-6955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00915700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: