Healthcare Provider Details

I. General information

NPI: 1306419130
Provider Name (Legal Business Name): CROY LAUGHLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 ROUTE 73 S STE 210
MARLTON NJ
08053-4133
US

IV. Provider business mailing address

PO BOX 306698
NASHVILLE TN
37230-6698
US

V. Phone/Fax

Practice location:
  • Phone: 856-399-1010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: