Healthcare Provider Details

I. General information

NPI: 1942342407
Provider Name (Legal Business Name): GEORGE YANSICK BA CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HARDING HIGHWAY
PITTSGROVE NJ
08318
US

IV. Provider business mailing address

3844 PINE STREET
WILLIAMSTOWN NJ
08094
US

V. Phone/Fax

Practice location:
  • Phone: 856-358-4111
  • Fax: 856-358-4120
Mailing address:
  • Phone: 856-262-9022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37CA00020200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: