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.

18517

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 provide comprehensive, high-quality substance use disorder and co-occurring mental health services for individuals and families, regardless of their ability to pay. Maryville is licensed by the state of New Jersey, accredited by CARF, and a member of the National Association of Addiction Treatment Providers.

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
Vineland, NJ 08360