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General NPI Number Information
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NPI Number | 1235747593
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Entity Type | Organization
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Legal Business Name | WHITE PINE CENTER FOR HEALING
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Dates
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Enumeration Date | 07/22/2020
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Last Update Date | 07/22/2020
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Provider Practice Location Address
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Address Line | 1116 W 7TH ST
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City | ERIE
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State | PA
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Zip | 16502-1104
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Country | US
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Telephone | 814-461-5617
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Fax |
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Provider Business Mailing Address
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Address Line | 1116 W 7TH ST
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City | ERIE
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State | PA
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Zip | 16502-1104
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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 | CLINICAL DIRECTOR
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Name | MRS. BRANDES MONTGOMERY
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Credential | MS, LPC
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Telephone | 814-431-2511
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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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