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General NPI Number Information
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NPI Number | 1922953199
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Entity Type | Organization
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Legal Business Name | AMBER PETCHONKA
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Dates
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Enumeration Date | 03/03/2026
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Last Update Date | 03/03/2026
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Provider Practice Location Address
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Address Line | 1135 VALLEY VIEW DR
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City | BANGOR
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State | PA
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Zip | 18013-5901
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Country | US
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Telephone | 484-860-4002
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Fax |
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Provider Business Mailing Address
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Address Line | 1135 VALLEY VIEW DR
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City | BANGOR
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State | PA
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Zip | 18013-5901
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Country | US
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Telephone | 484-860-4002
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Fax |
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Authorized Official
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Title or Position | LICENSED THERAPIST
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Name | AMBER PETCHONKA
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Credential | ATR-BC, LPC
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Telephone | 484-860-4002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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