| Doctor Name: | KEVIN FORD |
| NPI Number: | 1790180438 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 37LC00194600 |
| Business Practice Address: | 610 Pemberton Browns Mills Rd Pemberton, NJ - 080681537 |
| Business Phone Number: | 6097267155 |
| Business Fax Number: | |
| Mailing Address: | 610 Pemberton Browns Mills Rd, PEMBERTON |
| State: | NJ |
| Postal Code: | 080681537 |
| Phone Number: | 6097267155 |
| Fax Number: | |
| NPI Enumeration Date: | 10/23/2014 |
| NPI Last Update Date: | 10/23/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 37LC00194600 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |