=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508148875
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALLISON LEE MISKULIN LCADC, LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2011
-----------------------------------------------------
Last Update Date | 01/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 64 MUSCONETCONG AVE
-----------------------------------------------------
City | STANHOPE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07874-2939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-699-4918
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 64 MUSCONETCONG AVE
-----------------------------------------------------
City | STANHOPE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07874-2939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-699-4918
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 37LC00160800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 37PC00286000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------