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General NPI Number Information
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NPI Number | 1720671241
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Entity Type | Individual
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Provider Name | CORAL LIVELY
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Gender | Female
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Dates
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Enumeration Date | 02/16/2021
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 6079 MAIN ST
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City | EAST PETERSBURG
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State | PA
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Zip | 17520-1267
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Country | US
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Telephone | 855-272-1653
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Fax | 717-376-1712
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Provider Business Mailing Address
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Address Line | 200 N 7TH ST
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City | LEBANON
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State | PA
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Zip | 17046-5040
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Country | US
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Telephone | 717-272-5464
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Fax | 717-376-1712
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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