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General NPI Number Information
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NPI Number | 1659688166
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Entity Type | Individual
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Provider Name | KAREN A. B. DEHAVEN MA, BC-DMT, LPC
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Gender | Female
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Dates
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Enumeration Date | 09/03/2010
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Last Update Date | 09/03/2010
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Provider Practice Location Address
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Address Line | 171 E MAIN ST
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City | PERKASIE
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State | PA
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Zip | 18944-5422
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Country | US
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Telephone | 267-261-3779
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 103
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City | SILVERDALE
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State | PA
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Zip | 18962-0103
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Country | US
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Telephone | 267-261-3779
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC004483
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License Number State | PA
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