Healthcare Provider Details

I. General information

NPI: 1922771971
Provider Name (Legal Business Name): LORA ANN SHROCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 07/27/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 ORANGEVILLE RD
GREENVILLE PA
16125-9267
US

IV. Provider business mailing address

136 ORANGEVILLE RD
GREENVILLE PA
16125-9267
US

V. Phone/Fax

Practice location:
  • Phone: 724-815-1016
  • Fax:
Mailing address:
  • Phone: 724-815-1016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC013347
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: