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General NPI Number Information
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NPI Number | 1215799143
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Entity Type | Individual
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Provider Name | LUNA SULOLLARI
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Gender | Female
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Dates
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Enumeration Date | 01/25/2024
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Last Update Date | 11/30/2024
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Provider Practice Location Address
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Address Line | 2638 E COUNTY LINE RD
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City | ARDMORE
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State | PA
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Zip | 19003-2031
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Country | US
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Telephone | 484-580-9213
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Fax |
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Provider Business Mailing Address
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Address Line | 208 CANTERBURY DR
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City | BROOMALL
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State | PA
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Zip | 19008-3803
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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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