Healthcare Provider Details

I. General information

NPI: 1386354702
Provider Name (Legal Business Name): JODY STOOTHOFF LPC LCADC CCS ACS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 E. LANDIS AVE
VINELAND NJ
08361
US

IV. Provider business mailing address

54 GLENN TER
VINELAND NJ
08360-4926
US

V. Phone/Fax

Practice location:
  • Phone: 856-305-5699
  • Fax: 609-640-1701
Mailing address:
  • Phone: 856-305-5699
  • Fax: 609-640-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00630800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00285500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: