Provider Demographics
NPI:1417513169
Name:EXPRESS AND CONNECT ART THERAPY AND COUNSELING, LLC
Entity Type:Organization
Organization Name:EXPRESS AND CONNECT ART THERAPY AND COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LICENSED COUNSELOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:LINEBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, ATR-BC, LPC
Authorized Official - Phone:717-873-3084
Mailing Address - Street 1:835 EDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-4325
Mailing Address - Country:US
Mailing Address - Phone:717-873-3084
Mailing Address - Fax:717-219-5949
Practice Address - Street 1:835 EDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-4325
Practice Address - Country:US
Practice Address - Phone:717-873-3084
Practice Address - Fax:717-219-5949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-17
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1801916028OtherINDIVIDUAL NPI