Healthcare Provider Details

I. General information

NPI: 1134927643
Provider Name (Legal Business Name): SEXUAL WELLNESS PA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 CAUGHEY RD STE 200
ERIE PA
16506-4098
US

IV. Provider business mailing address

561 W 31ST ST
ERIE PA
16508-1742
US

V. Phone/Fax

Practice location:
  • Phone: 814-580-8677
  • Fax: 888-690-4135
Mailing address:
  • Phone: 814-580-8677
  • Fax: 888-690-4135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MIRANDA GALBREATH
Title or Position: OWNER
Credential: LPC, CST
Phone: 814-580-8677