Healthcare Provider Details

I. General information

NPI: 1386355113
Provider Name (Legal Business Name): HILKIAH FAMILY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 12/13/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 UPLAND STREET APT A
SPRINGFIELD PA
19013
US

IV. Provider business mailing address

491 BALTIMORE PIKE STE 1117
SPRINGFIELD PA
19064-3810
US

V. Phone/Fax

Practice location:
  • Phone: 888-823-4833
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KRYSTALYN DAVIS
Title or Position: OWNER
Credential: LCSW
Phone: 888-823-4833