Provider Demographics
NPI:1235821190
Name:KREIDER, SOPHIA ELLIS LAUREN (LPC)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ELLIS LAUREN
Last Name:KREIDER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:SOPHIA
Other - Last Name:KREIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:603 STATE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2640
Mailing Address - Country:US
Mailing Address - Phone:610-416-9391
Mailing Address - Fax:
Practice Address - Street 1:603 STATE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2640
Practice Address - Country:US
Practice Address - Phone:610-416-9391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004975101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional