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General NPI Number Information
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NPI Number | 1104710169
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Entity Type | Organization
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Legal Business Name | HEALING GROVE COUNSELING LLC
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 18 COMO RD
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City | LAKEWOOD
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State | PA
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Zip | 18439-3971
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Country | US
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Telephone | 570-470-5730
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Fax |
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Provider Business Mailing Address
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Address Line | 182 ROSE HILL RD
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City | LAKE COMO
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State | PA
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Zip | 18437-1007
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Country | US
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Telephone | 570-470-5730
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | CARRIE GILL
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Credential | LPC, LBS
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Telephone | 570-470-5730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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