Healthcare Provider Details

I. General information

NPI: 1629753645
Provider Name (Legal Business Name): ADAM MCDIVITT MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/19/2023
Certification Date: 06/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 WASHINGTON RD
MC MURRAY PA
15317-3279
US

IV. Provider business mailing address

1150 2ND ST
FAYETTE CITY PA
15438-1032
US

V. Phone/Fax

Practice location:
  • Phone: 724-260-0550
  • Fax:
Mailing address:
  • Phone: 724-984-1873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC011319
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: