Healthcare Provider Details

I. General information

NPI: 1548447444
Provider Name (Legal Business Name): JORDAN ELYSE CUPELLI-KNIGHT MS, CAADC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 CUMBERLAND ST STE 211
LEBANON PA
17042-5231
US

IV. Provider business mailing address

120 TIVERTON CT
LEBANON PA
17042-4160
US

V. Phone/Fax

Practice location:
  • Phone: 717-514-2804
  • Fax:
Mailing address:
  • Phone: 717-514-2804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC005947
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: