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General NPI Number Information
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NPI Number | 1245150044
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Entity Type | Organization
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Legal Business Name | KINTSUGI COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 07/20/2026
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Last Update Date | 07/20/2026
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Provider Practice Location Address
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Address Line | 760 CONSTITUTION DR STE 106
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City | EXTON
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State | PA
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Zip | 19341-1149
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Country | US
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Telephone | 570-594-6911
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Fax |
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Provider Business Mailing Address
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Address Line | 63 MEADOWLAKE DR
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City | DOWNINGTOWN
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State | PA
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Zip | 19335-2134
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Country | US
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Telephone | 570-594-6911
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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 | JORDAN JUSTINE SCHROCK
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Credential |
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Telephone | 570-594-6911
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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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