Healthcare Provider Details

I. General information

NPI: 1952265902
Provider Name (Legal Business Name): ELIZABETH ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KEYSTONE AVE STE 1
EMMAUS PA
18049-2625
US

IV. Provider business mailing address

PO BOX 612
RICHLANDTOWN PA
18955-0612
US

V. Phone/Fax

Practice location:
  • Phone: 717-462-7003
  • Fax:
Mailing address:
  • Phone: 717-462-7003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC001955
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: