Healthcare Provider Details

I. General information

NPI: 1881119493
Provider Name (Legal Business Name): CORE TREATMENT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 ANDORRA GLEN CT STE 7
LAFAYETTE HILL PA
19444-2531
US

IV. Provider business mailing address

555 ANDORRA GLEN CT STE 7
LAFAYETTE HILL PA
19444-2531
US

V. Phone/Fax

Practice location:
  • Phone: 609-332-9967
  • Fax:
Mailing address:
  • Phone: 609-332-9967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberPC006334
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberPC006334
License Number StatePA

VIII. Authorized Official

Name: HEATHER GREGAN
Title or Position: MENTAL HEALTH COUNSELOR
Credential: LPC
Phone: 609-332-9967