Provider Demographics
NPI:1902529126
Name:GODISINC LLC
Entity Type:Organization
Organization Name:GODISINC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABUSE COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAGEE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MHS, LCADC
Authorized Official - Phone:856-332-0290
Mailing Address - Street 1:35 S BURLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-2262
Mailing Address - Country:US
Mailing Address - Phone:856-332-0290
Mailing Address - Fax:
Practice Address - Street 1:35 S BURLINGTON RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-2262
Practice Address - Country:US
Practice Address - Phone:856-332-0290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37LC00205500OtherLCADC LICENSE NUMBER