Provider Demographics
NPI:1497307912
Name:AZURE PERSONAL GROWTH AND COUNSELING, LLC
Entity Type:Organization
Organization Name:AZURE PERSONAL GROWTH AND COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:KIMBER
Authorized Official - Suffix:
Authorized Official - Credentials:MSS, MLSP, LCSW
Authorized Official - Phone:215-544-5237
Mailing Address - Street 1:133 HEATHER RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3009
Mailing Address - Country:US
Mailing Address - Phone:215-544-5237
Mailing Address - Fax:
Practice Address - Street 1:133 HEATHER RD
Practice Address - Street 2:SUITE 205
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3009
Practice Address - Country:US
Practice Address - Phone:215-544-5237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-15
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health