Healthcare Provider Details

I. General information

NPI: 1487306494
Provider Name (Legal Business Name): INCLUSIVE COUNSELING CENTER LLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 W WELSH POOL RD STE 103
EXTON PA
19341-1233
US

IV. Provider business mailing address

80 W WELSH POOL RD STE 103S
EXTON PA
19341-1233
US

V. Phone/Fax

Practice location:
  • Phone: 484-753-5547
  • Fax:
Mailing address:
  • Phone: 484-753-5547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: LISA KATHERINE WOOD
Title or Position: OWNER / CLINICIAN
Credential: LCSW
Phone: 484-753-5547