Provider Demographics
NPI:1770364101
Name:BATTLE, TYQUAAN (CADC)
Entity type:Individual
Prefix:
First Name:TYQUAAN
Middle Name:
Last Name:BATTLE
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 SPRINFIELD AVENUE
Mailing Address - Street 2:#255
Mailing Address - City:VAUXHALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07088-9998
Mailing Address - Country:US
Mailing Address - Phone:862-384-9901
Mailing Address - Fax:
Practice Address - Street 1:2215 SPRINFIELD AVENUE
Practice Address - Street 2:#255
Practice Address - City:VAUXHALL
Practice Address - State:NJ
Practice Address - Zip Code:07088-9998
Practice Address - Country:US
Practice Address - Phone:862-384-9901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37CA00186700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)