Healthcare Provider Details

I. General information

NPI: 1689801938
Provider Name (Legal Business Name): NICOLE LADSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2009
Last Update Date: 06/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218A SUNSET RD SCREENING, CRISIS & INTERVENTION PROGRAM (SCIP)
WILLINGBORO NJ
08046-1110
US

IV. Provider business mailing address

218A SUNSET RD SCREENING, CRISIS & INTERVENTION PROGRAM (SCIP)
WILLINGBORO NJ
08046-1110
US

V. Phone/Fax

Practice location:
  • Phone: 609-835-6180
  • Fax: 609-835-7962
Mailing address:
  • Phone: 609-835-6180
  • Fax: 609-835-7962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00368500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: