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General NPI Number Information
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NPI Number | 1245553734
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Entity Type | Individual
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Provider Name | AMANDA LEIGH VITALI LPC
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Gender | Female
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 03/11/2010
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Provider Practice Location Address
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Address Line | 403 SPINNER RD
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City | HONESDALE
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State | PA
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Zip | 18431-7634
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Country | US
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Telephone | 570-253-9323
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 362
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City | LAKE ARIEL
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State | PA
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Zip | 18436-0362
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Country | US
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Telephone | 570-878-8561
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC004603
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License Number State | PA
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