Provider Demographics
NPI:1003539511
Name:CLOVER LEAF COUNSELING CENTER, LLC.
Entity Type:Organization
Organization Name:CLOVER LEAF COUNSELING CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:EBERLE- JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:570-847-4623
Mailing Address - Street 1:23 CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-7960
Mailing Address - Country:US
Mailing Address - Phone:570-847-4623
Mailing Address - Fax:
Practice Address - Street 1:273 E 7TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-2853
Practice Address - Country:US
Practice Address - Phone:570-507-7170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty