Provider Demographics
NPI:1043742828
Name:SOBER, JILL WYNNE (MA LPC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:WYNNE
Last Name:SOBER
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:WYNNE
Other - Last Name:SOBER-WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA LPC
Mailing Address - Street 1:1 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522-1323
Mailing Address - Country:US
Mailing Address - Phone:610-944-0445
Mailing Address - Fax:610-944-8834
Practice Address - Street 1:22-24 N. FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:FLEETWOOD
Practice Address - State:PA
Practice Address - Zip Code:19522
Practice Address - Country:US
Practice Address - Phone:610-944-0445
Practice Address - Fax:610-944-1196
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009143101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional