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General NPI Number Information
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NPI Number | 1912169103
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Entity Type | Individual
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Provider Name | JACQUELINE C PORTER-STEWART LCADC, LCSW, SAP,
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Gender | Female
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Dates
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Enumeration Date | 06/28/2008
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Last Update Date | 04/30/2020
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Provider Practice Location Address
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Address Line | 20 NASSAU ST SUITE 204
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City | PRINCETON
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State | NJ
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Zip | 08542-4509
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Country | US
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Telephone | 609-454-3080
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Fax | 609-454-3078
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Provider Business Mailing Address
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Address Line | SUPPLANTER COUNSELING & MEDIATION, LLC 1330 PARKWAY AVENUE, STE. 12
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City | EWING
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State | NJ
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Zip | 08628-4509
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Country | US
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Telephone | 609-454-3080
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Fax | 609-454-3078
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05534200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37LC00133600
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License Number State | NJ
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