Healthcare Provider Details

I. General information

NPI: 1841881273
Provider Name (Legal Business Name): ALPHA & OMEGA COUNSELING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 HAMLIN HWY STE 3
LAKE ARIEL PA
18436-9307
US

IV. Provider business mailing address

612 HAMLIN HWY STE 3
LAKE ARIEL PA
18436-9307
US

V. Phone/Fax

Practice location:
  • Phone: 570-951-7278
  • Fax:
Mailing address:
  • Phone: 570-951-7278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN SHAFER
Title or Position: PRESIDENT
Credential:
Phone: 570-951-7278