Healthcare Provider Details

I. General information

NPI: 1891271714
Provider Name (Legal Business Name): LIFE IN PROGRESS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 MARCHWOOD RD STE 1-J1
EXTON PA
19341
US

IV. Provider business mailing address

47 MARCHWOOD RD STE 1-J1
EXTON PA
19341-1835
US

V. Phone/Fax

Practice location:
  • Phone: 484-876-1842
  • Fax:
Mailing address:
  • Phone: 484-876-1842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC010020
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MARK WIELAND
Title or Position: OWNER
Credential: LPC
Phone: 484-876-1842