Provider Demographics
NPI:1255870721
Name:LAURIE A PATTERSON LLC
Entity Type:Organization
Organization Name:LAURIE A PATTERSON LLC
Other - Org Name:WAYFARERS COUNSELING
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:610-209-2837
Mailing Address - Street 1:8600 W CHESTER PIKE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-2629
Mailing Address - Country:US
Mailing Address - Phone:610-387-6056
Mailing Address - Fax:
Practice Address - Street 1:717 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-2401
Practice Address - Country:US
Practice Address - Phone:610-209-2837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0148751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty