Healthcare Provider Details

I. General information

NPI: 1023883030
Provider Name (Legal Business Name): ANNASTHASIA WRYE MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNASTHASIA CORBIN MA

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 STONE RIDGE RD
PHILIPSBURG PA
16866-8943
US

IV. Provider business mailing address

122 STONE RIDGE RD
PHILIPSBURG PA
16866-8943
US

V. Phone/Fax

Practice location:
  • Phone: 240-587-0149
  • Fax:
Mailing address:
  • Phone: 240-587-0149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC016446
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: