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General NPI Number Information
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NPI Number | 1104475953
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Entity Type | Organization
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Legal Business Name | PAC CENTER OF HEALING AND WELLNESS, LLC
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Dates
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Enumeration Date | 09/04/2019
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 4150 W MARKET ST
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City | YORK
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State | PA
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Zip | 17408-5934
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Country | US
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Telephone | 717-650-6583
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Fax | 717-793-2165
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Provider Business Mailing Address
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Address Line | 4150 W MARKET ST
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City | YORK
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State | PA
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Zip | 17408-5934
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Country | US
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Telephone | 717-650-6583
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Fax | 717-793-2165
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Authorized Official
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Title or Position | PRESIDENT/THERAPIST
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Name | KIM JANE SANDERS
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Credential | MA, LPC
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Telephone | 717-650-6583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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