Healthcare Provider Details

I. General information

NPI: 1285819987
Provider Name (Legal Business Name): VAN INGEN COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/01/2008
Last Update Date: 07/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 E MAIN ST SUITE 1
EVANS CITY PA
16033-1261
US

IV. Provider business mailing address

217 E MAIN ST SUITE 1
EVANS CITY PA
16033-1261
US

V. Phone/Fax

Practice location:
  • Phone: 724-538-3103
  • Fax:
Mailing address:
  • Phone: 724-538-3103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW015661
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. STEPHANIE VAN INGEN
Title or Position: PRESIDENT
Credential: LCSW
Phone: 724-538-3103