Healthcare Provider Details

I. General information

NPI: 1740102599
Provider Name (Legal Business Name): DAMARIS DEBORA MIKESELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 HAMPDEN DR
YORK PA
17408-9301
US

IV. Provider business mailing address

4150 W MARKET ST
YORK PA
17408-5934
US

V. Phone/Fax

Practice location:
  • Phone: 214-431-2290
  • Fax:
Mailing address:
  • Phone: 717-650-6583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: