Healthcare Provider Details

I. General information

NPI: 1558178541
Provider Name (Legal Business Name): RECOVER PSYCHOTHERAPY & COUNSELING SERVICESLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 BROOKSIDE RD STE 80
ALLENTOWN PA
18106-9023
US

IV. Provider business mailing address

4403 BIRKLAND PL # 1010
EASTON PA
18045-4701
US

V. Phone/Fax

Practice location:
  • Phone: 484-867-7078
  • Fax: 833-381-0909
Mailing address:
  • Phone: 484-867-7078
  • Fax: 833-381-0909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: AMY RUDISILL
Title or Position: OWNER
Credential: LPC
Phone: 484-867-7078