Healthcare Provider Details

I. General information

NPI: 1245150044
Provider Name (Legal Business Name): KINTSUGI COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 CONSTITUTION DR STE 106
EXTON PA
19341-1149
US

IV. Provider business mailing address

63 MEADOWLAKE DR
DOWNINGTOWN PA
19335-2134
US

V. Phone/Fax

Practice location:
  • Phone: 570-594-6911
  • Fax:
Mailing address:
  • Phone: 570-594-6911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JORDAN JUSTINE SCHROCK
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential:
Phone: 570-594-6911