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General NPI Number Information
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NPI Number | 1457084345
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Entity Type | Individual
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Provider Name | MAXWELL ST. JOHN LPC
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Gender | Male
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Dates
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Enumeration Date | 07/07/2022
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 2312 WHITEHORSE MERCERVILLE RD STE 205
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City | HAMILTON
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State | NJ
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Zip | 08619-1953
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Country | US
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Telephone | 215-617-0861
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Fax |
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Provider Business Mailing Address
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Address Line | 550 W QUEEN LN
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City | PHILADELPHIA
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State | PA
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Zip | 19144-4052
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Country | US
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Telephone | 180-557-0157
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC014669
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License Number State | PA
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