Provider Demographics
NPI:1861086712
Name:DEJEAN, ACHILLE (LPC)
Entity type:Individual
Prefix:
First Name:ACHILLE
Middle Name:
Last Name:DEJEAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:674 TABOR RD
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-2727
Mailing Address - Country:US
Mailing Address - Phone:973-280-9797
Mailing Address - Fax:
Practice Address - Street 1:317 GODWIN AVE STE 3
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1547
Practice Address - Country:US
Practice Address - Phone:201-444-8103
Practice Address - Fax:201-444-8105
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00656000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty