Healthcare Provider Details

I. General information

NPI: 1912176413
Provider Name (Legal Business Name): COUNSELING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 S VALLEY RD
PAOLI PA
19301-1465
US

IV. Provider business mailing address

20 S VALLEY RD
PAOLI PA
19301-1465
US

V. Phone/Fax

Practice location:
  • Phone: 610-647-8270
  • Fax: 610-647-3279
Mailing address:
  • Phone: 610-647-8270
  • Fax: 610-647-3279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS000152L
License Number StatePA

VIII. Authorized Official

Name: MARTIN ZLOTOWSKI
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 610-647-8270