Healthcare Provider Details

I. General information

NPI: 1114676061
Provider Name (Legal Business Name): ANNA'S ALCOVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2022
Last Update Date: 03/19/2022
Certification Date: 03/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 W 3RD ST
LANSDALE PA
19446-2111
US

IV. Provider business mailing address

20 VINE ST UNIT 1102
LANSDALE PA
19446-8757
US

V. Phone/Fax

Practice location:
  • Phone: 267-458-2927
  • Fax: 267-291-6468
Mailing address:
  • Phone: 267-458-2927
  • Fax: 267-291-6468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANNA DWYER SKINNER
Title or Position: OWNER
Credential: MED, NCC, LPC, CAADC
Phone: 267-458-2927