IDRC Program Form

First Name*
First
Last Name*
Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email Address*
Class Date
MM slash DD slash YYYY
Summons Number and/or Driver’s License Number*
IDRC Program Payment*
Price:
Cost includes a $9 convenience fee.
After clicking submit, you will be taken to another form that will direct you to Square for payment.

526 South Burnt Mill Road
Voorhees, NJ 08043

(855) 823-3428

info@maryvillenj.org

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Maryville is a nonprofit organization with a mission to help individuals and families improve their health and wellness by providing high quality integrated mental health, physical health, and substance use treatment, recovery supports, and education. Maryville is licensed by the state of New Jersey, accredited by CARF International, and a member of the New Jersey Association of Mental Health and Addiction Agencies.

Inpatient

1903 Grant Avenue
Williamstown, NJ 08094

610 Pemberton Browns Mills Road
Pemberton, NJ 08068

Outpatient

129 Johnson Road, Suite 7
Turnersville, NJ 08012

1173 E. Landis Avenue, Suite 202
Vineland, NJ 08360