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General NPI Number Information
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NPI Number | 1356770192
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Entity Type | Organization
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Legal Business Name | LIFESPIRE LLC
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Dates
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Enumeration Date | 11/02/2013
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 207 HOUSE AVE STE 109
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City | CAMP HILL
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State | PA
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Zip | 17011-2308
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Country | US
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Telephone | 717-745-6166
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Fax |
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Provider Business Mailing Address
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Address Line | 207 HOUSE AVE STE 109
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City | CAMP HILL
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State | PA
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Zip | 17011-2308
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Country | US
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Telephone | 717-745-6166
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST/OWNER
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Name | DR. JAMIE MARIE BOLTON
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Credential | PSY.D.
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Telephone | 717-745-6166
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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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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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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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