Provider Demographics
NPI:1528302619
Name:KEREKES, MICHELLE (LPC, LCADC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:KEREKES
Suffix:
Gender:F
Credentials:LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 GARRETT DR
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-9648
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13 W RIVER RD STE C
Practice Address - Street 2:
Practice Address - City:RUMSON
Practice Address - State:NJ
Practice Address - Zip Code:07760-1438
Practice Address - Country:US
Practice Address - Phone:954-815-6268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00267700101YA0400X
NJ37PC00558500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)