Healthcare Provider Details

I. General information

NPI: 1861046922
Provider Name (Legal Business Name): CHRISTINA H KUO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2019
Last Update Date: 07/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 CHESTNUT RD STE 6A
PAOLI PA
19301-1535
US

IV. Provider business mailing address

29 SULLIVAN RD
WAYNE PA
19087-1431
US

V. Phone/Fax

Practice location:
  • Phone: 484-802-7022
  • Fax:
Mailing address:
  • Phone: 484-802-7022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: