=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518300599
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A WILL AND A WAY COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2013
-----------------------------------------------------
Last Update Date | 04/09/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 644 E CYPRESS ST
-----------------------------------------------------
City | KENNETT SQUARE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19348-2447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-764-8652
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 PINECREST DR
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19810-1414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-764-8652
-----------------------------------------------------
Fax | 302-478-7590
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PROFESSIONAL COUNSELOR
-----------------------------------------------------
Name | MRS. JULIE DONAHUE
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 610-764-8652
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | PC-0000548
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------