Healthcare Provider Details

I. General information

NPI: 1447949805
Provider Name (Legal Business Name): TELEHEALTH COUNSELING SERVICES OF PENNSYLVANIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 E MAIN ST # 156
MOUNT JOY PA
17552-9347
US

IV. Provider business mailing address

929 E MAIN ST # 156
MOUNT JOY PA
17552-9347
US

V. Phone/Fax

Practice location:
  • Phone: 717-940-9012
  • Fax: 717-928-4443
Mailing address:
  • Phone: 717-940-9012
  • Fax: 717-928-4443

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

VIII. Authorized Official

Name: DEWANA HALL
Title or Position: SOLE MEMBER
Credential: LPC, PHD, CADC, CCJP
Phone: 717-940-9012