Provider Demographics
NPI:1194943837
Name:ST.JOHN, CAROL ANN (LCADC)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:ST.JOHN
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 PROSPECT AVE APT 10B
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2559
Mailing Address - Country:US
Mailing Address - Phone:201-447-5909
Mailing Address - Fax:
Practice Address - Street 1:380 PROSPECT AVE APT 10B
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2559
Practice Address - Country:US
Practice Address - Phone:201-447-5909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00125300101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)