Provider Demographics
NPI:1033867023
Name:PELC, MADELINE GRACE (MS, NCC, LPC, CCTP)
Entity Type:Individual
Prefix:MISS
First Name:MADELINE
Middle Name:GRACE
Last Name:PELC
Suffix:
Gender:F
Credentials:MS, NCC, LPC, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 FILMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4127
Mailing Address - Country:US
Mailing Address - Phone:814-273-9773
Mailing Address - Fax:
Practice Address - Street 1:823 FILMORE AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4127
Practice Address - Country:US
Practice Address - Phone:814-273-9773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013539101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional