Provider Demographics
NPI:1861053456
Name:MCDONALD, YVETTE (LCADC)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:
Last Name:MCDONALD
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 1:3224 HAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-3200
Mailing Address - Country:US
Mailing Address - Phone:609-335-9643
Mailing Address - Fax:
Practice Address - Street 1:313 E JIMMIE LEEDS RD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4129
Practice Address - Country:US
Practice Address - Phone:609-498-6009
Practice Address - Fax:609-241-6573
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00276100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)