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General NPI Number Information
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NPI Number | 1265140370
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Entity Type | Individual
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Provider Name | STACEY DAMKOHLER LPC
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Gender | Female
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Dates
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Enumeration Date | 11/08/2022
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 343 OLD GEORGES RD STE 201
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City | NORTH BRUNSWICK
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State | NJ
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Zip | 08902-4801
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Country | US
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Telephone | 609-969-3009
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Fax |
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Provider Business Mailing Address
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Address Line | 315 KENT LN
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City | KENTS STORE
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State | VA
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Zip | 23084-2269
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Country | US
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Telephone | 609-969-3009
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 21307
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC01138700
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License Number State | NJ
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