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General NPI Number Information
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NPI Number | 1467992032
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Entity Type | Individual
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Provider Name | STANLEY THEODOREDIS LPC, CAADC
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Gender | Male
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Dates
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Enumeration Date | 03/02/2017
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Last Update Date | 02/15/2018
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Provider Practice Location Address
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Address Line | 42 MAIN ST
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City | HELLERTOWN
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State | PA
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Zip | 18055-1743
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Country | US
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Telephone | 610-730-3422
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Fax |
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Provider Business Mailing Address
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Address Line | 2045 WESTGATE DR STE 206
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City | BETHLEHEM
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State | PA
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Zip | 18017-7475
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Country | US
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Telephone | 610-740-4575
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | PC009228
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PC009228
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License Number State | PA
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