Healthcare Provider Details

I. General information

NPI: 1902171531
Provider Name (Legal Business Name): SCRANTON COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 ADAMS AVE SCRANTON
SCRANTON PA
18503-1604
US

IV. Provider business mailing address

326 ADAMS AVE SCRANTON
SCRANTON PA
18503-1604
US

V. Phone/Fax

Practice location:
  • Phone: 570-348-6100
  • Fax:
Mailing address:
  • Phone: 570-348-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberCW017203
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CONSTANCE SHEAN
Title or Position: PROGRAM DIRECTOR - SBBH
Credential: LCSW
Phone: 570-348-6100