Healthcare Provider Details

I. General information

NPI: 1346907276
Provider Name (Legal Business Name): FOUR WINDS CENTER FOR HEALING AND THE ARTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2021
Last Update Date: 11/28/2021
Certification Date: 11/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 SUNNYSIDE RD APT 1
TUNKHANNOCK PA
18657-6946
US

IV. Provider business mailing address

6 SUNNYSIDE RD APT 1
TUNKHANNOCK PA
18657-6946
US

V. Phone/Fax

Practice location:
  • Phone: 570-836-7777
  • Fax:
Mailing address:
  • Phone: 570-836-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. MAYA W NOBLE
Title or Position: CEO, LICENSED ACUPUNCTURIST
Credential: DACM, DOM, L.AC.
Phone: 570-836-7777