Provider Demographics
NPI:1992545552
Name:BRISTOL, ALBERT III (LAC)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:BRISTOL
Suffix:III
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-3313
Mailing Address - Country:US
Mailing Address - Phone:732-616-0573
Mailing Address - Fax:
Practice Address - Street 1:26 EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-3313
Practice Address - Country:US
Practice Address - Phone:732-616-0573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00596400101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor