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General NPI Number Information
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NPI Number | 1245033141
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Entity Type | Organization
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Legal Business Name | THE WILLOW SPACE FOR TRAUMA TREATMENT LLC
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Dates
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Enumeration Date | 03/28/2025
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 1770 LANCASTER AVE STE 12
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City | PAOLI
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State | PA
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Zip | 19301-1575
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Country | US
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Telephone | 484-442-0832
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Fax |
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Provider Business Mailing Address
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Address Line | 1770 LANCASTER AVE STE 12
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City | PAOLI
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State | PA
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Zip | 19301-1575
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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 | CO-OWNER
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Name | ERIN ZIEGELMEYER
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Credential | MA
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Telephone | 513-255-1546
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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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