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General NPI Number Information
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NPI Number | 1154680452
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Entity Type | Organization
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Legal Business Name | A HEALING PATH COUNSELING LLC
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Dates
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Enumeration Date | 05/08/2012
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Last Update Date | 11/16/2012
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Provider Practice Location Address
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Address Line | 159 BLUE VALLEY DR
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City | BANGOR
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State | PA
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Zip | 18013-1511
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Country | US
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Telephone | 610-452-9199
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Fax | 610-452-9218
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Provider Business Mailing Address
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Address Line | 159 BLUE VALLEY DR
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City | BANGOR
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State | PA
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Zip | 18013-1511
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Country | US
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Telephone | 610-452-9199
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Fax | 610-452-9218
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MR. ANDREW MARK RACHLIN
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Credential |
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Telephone | 570-350-1760
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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 | PC003341
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License Number State | PA
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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 | CW016549
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW017025
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW014501
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License Number State | PA
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