MEDICARE: LILAC RIVER COUNSELING , LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1417660085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LILAC RIVER COUNSELING , LLC

Provider Business Mailing Address
First Line	:	1250 N MOUNTAIN RD STE 307
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17112-1795
Country	:	US
Telephone Number	:	717-585-0098
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 N MOUNTAIN RD STE 307
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17112-1795
Country	:	US
Telephone Number	:	717-585-0098
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST/OWNER
Name	:	KIMBERLY HARFORD
Credential	:	LCSW
Telephone Number	:	717-651-1180

Provider Enumeration Date	:	12/28/2022
Last Update Date	:	12/28/2022

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