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General NPI Number Information
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NPI Number | 1598130916
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Entity Type | Organization
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Legal Business Name | MAIN LINE ADULT COUNSELING, LLC
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Dates
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Enumeration Date | 12/10/2015
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Last Update Date | 03/10/2016
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Provider Practice Location Address
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Address Line | 252 VINCENT RD
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City | PAOLI
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State | PA
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Zip | 19301-1127
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Country | US
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Telephone | 484-343-6136
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Fax |
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Provider Business Mailing Address
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Address Line | 252 VINCENT RD
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City | PAOLI
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State | PA
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Zip | 19301-1127
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Country | US
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Telephone | 484-343-6136
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER/PSYCHOTHERAPIST
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Name | MARGARET L PHIPPS
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Credential | LCSW
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Telephone | 484-343-6136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW017851
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License Number State | PA
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