Provider Demographics
NPI:1487191326
Name:COMPREHENSIVE CARE COUNSELING LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE CARE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:HACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:717-775-8078
Mailing Address - Street 1:2215 FOREST HILLS DR STE 36
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-1099
Mailing Address - Country:US
Mailing Address - Phone:717-775-8078
Mailing Address - Fax:
Practice Address - Street 1:2215 FOREST HILLS DR STE 36
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-1099
Practice Address - Country:US
Practice Address - Phone:717-775-8078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC-001656101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1487191326Medicaid