Healthcare Provider Details

I. General information

NPI: 1679484497
Provider Name (Legal Business Name): PARK COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 N PRINCE ST STE 108
LANCASTER PA
17603-2732
US

IV. Provider business mailing address

812 N PRINCE ST STE 108
LANCASTER PA
17603-2732
US

V. Phone/Fax

Practice location:
  • Phone: 717-723-9770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARIA DETWEILER
Title or Position: COUNSELOR
Credential: LPC
Phone: 717-690-6630