=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770463887
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOUR CUPS: COUNSELING AND CONSULTING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2025
-----------------------------------------------------
Last Update Date | 09/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2643 N 3RD ST STE 2-302
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17110-2048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-551-9119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 134 ROBIN LN APT O4
-----------------------------------------------------
City | HUMMELSTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17036-8239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-557-9119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE MEMBER/THERAPIST
-----------------------------------------------------
Name | CAANEN CHURUKHA
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 717-524-8165
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------