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General NPI Number Information
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NPI Number | 1457518284
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Entity Type | Individual
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Provider Name | CAROL MARY CONWAY-CLOUGH LCADC, CAC
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Gender | Female
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 250 HALF MILE RD
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City | RED BANK
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State | NJ
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Zip | 07701-5695
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Country | US
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Telephone | 732-747-7734
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Fax | 732-747-7734
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Provider Business Mailing Address
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Address Line | 250 HALF MILE RD
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City | RED BANK
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State | NJ
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Zip | 07701-5695
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Country | US
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Telephone | 732-747-7734
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Fax | 732-747-7734
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37LC00030400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 37LC00030400
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License Number State | NJ
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