Provider Demographics
NPI:1083055420
Name:LIGONIER VALLEY LEARNING CENTER
Entity Type:Organization
Organization Name:LIGONIER VALLEY LEARNING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FAULK
Authorized Official - Suffix:
Authorized Official - Credentials:MED,CRC, LPC
Authorized Official - Phone:724-238-0355
Mailing Address - Street 1:117 JUNIPER LN
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-9727
Mailing Address - Country:US
Mailing Address - Phone:724-238-0355
Mailing Address - Fax:
Practice Address - Street 1:117 JUNIPER LN
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-9727
Practice Address - Country:US
Practice Address - Phone:724-238-0355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW130426104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty