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General NPI Number Information
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NPI Number | 1790408649
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Entity Type | Individual
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Provider Name | NINA ALEXANDRA JUDD LPC
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Gender | Female
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Dates
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Enumeration Date | 09/26/2022
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Last Update Date | 09/26/2022
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Provider Practice Location Address
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Address Line | 1420 WALNUT ST STE 802
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City | PHILADELPHIA
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State | PA
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Zip | 19102-4008
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Country | US
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Telephone | 610-544-2110
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Fax |
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Provider Business Mailing Address
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Address Line | 845 CHURCH RD
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City | HARLEYSVILLE
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State | PA
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Zip | 19438-2852
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Country | US
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Telephone |
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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 | PC014745
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License Number State | PA
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