Healthcare Provider Details

I. General information

NPI: 1073381844
Provider Name (Legal Business Name): SEBASTIAN RIMEHAUG LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6122 RIDGE AVE
PHILADELPHIA PA
19128-1603
US

IV. Provider business mailing address

3902 LANCASTER AVE # 3
PHILADELPHIA PA
19104-4606
US

V. Phone/Fax

Practice location:
  • Phone: 215-487-1330
  • Fax:
Mailing address:
  • Phone: 315-786-4643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC016456
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: