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General NPI Number Information
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NPI Number | 1598088734
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Entity Type | Organization
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Legal Business Name | CHILD AND ADOLESCENT COUNSELING SERVICES OF SOUTHEASTERN PA.
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Dates
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Enumeration Date | 03/02/2010
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Last Update Date | 03/02/2010
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Provider Practice Location Address
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Address Line | 220 W GAY ST
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City | WEST CHESTER
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State | PA
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Zip | 19380-2917
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Country | US
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Telephone | 610-764-8655
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Fax |
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Provider Business Mailing Address
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Address Line | 220 W GAY ST
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City | WEST CHESTER
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State | PA
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Zip | 19380-2917
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Country | US
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Telephone | 610-764-8655
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MS. PAMELA JANE VAN DER LAAN
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Credential | MHS, CAC, CCJS
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Telephone | 484-769-9109
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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 | 2314
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License Number State | PA
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