Healthcare Provider Details

I. General information

NPI: 1629995055
Provider Name (Legal Business Name): AVIA LUCHAINE TOMLINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WALNUT ST STE 100
LANSDALE PA
19446-1144
US

IV. Provider business mailing address

1000 WALNUT ST STE 100
LANSDALE PA
19446-1144
US

V. Phone/Fax

Practice location:
  • Phone: 267-263-2246
  • Fax: 267-649-7374
Mailing address:
  • Phone: 267-263-2246
  • Fax: 267-649-7374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC005595
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: