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General NPI Number Information
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NPI Number | 1972391654
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Entity Type | Organization
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Legal Business Name | VIRIDITAS LLC
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Dates
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Enumeration Date | 04/30/2025
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 1307 PARK AVE STE 10-223
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-4590
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Country | US
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Telephone | 401-315-4644
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Fax |
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Provider Business Mailing Address
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Address Line | 957 MOSQUITO VALLEY RD
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City | WILLIAMSPORT
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State | PA
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Zip | 17702-8729
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Country | US
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Telephone | 401-315-4644
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Fax |
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Authorized Official
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Title or Position | OWNER, PSYCHOTHERAPIST
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Name | KATYA VALLON
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Credential |
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Telephone | 401-315-4644
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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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