Healthcare Provider Details

I. General information

NPI: 1699754424
Provider Name (Legal Business Name): HARBOR COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7095 ROUTE 287
WELLSBORO PA
16901-6711
US

IV. Provider business mailing address

7095 ROUTE 287
WELLSBORO PA
16901-6711
US

V. Phone/Fax

Practice location:
  • Phone: 570-724-5272
  • Fax: 570-724-4512
Mailing address:
  • Phone: 570-724-5272
  • Fax: 570-724-4512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number597013
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number597013
License Number StatePA

VIII. Authorized Official

Name: LAURIE SUE ROOF
Title or Position: PROJECT DIRECTOR
Credential:
Phone: 570-724-5272