=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710569983
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSANNE SINDICICH-KULP MED, LPC, LBSC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2021
-----------------------------------------------------
Last Update Date | 10/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2351 FREEDOM WAY STE 200
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17402-9282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-600-0900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2109 SAND BANK HILL RD
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17403-4268
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-801-2305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | PC013253
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------