Provider Demographics
NPI:1508192816
Name:SERRANO, MIJA E (LPC)
Entity Type:Individual
Prefix:
First Name:MIJA
Middle Name:E
Last Name:SERRANO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MIJA
Other - Middle Name:
Other - Last Name:GIBBONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-339-2710
Mailing Address - Fax:717-339-2711
Practice Address - Street 1:40 V TWIN DR STE 202
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-7878
Practice Address - Country:US
Practice Address - Phone:717-339-2710
Practice Address - Fax:717-339-2711
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011601101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional