Provider Demographics
NPI:1508501362
Name:IVEY, CIARA MARIE (MS, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:CIARA
Middle Name:MARIE
Last Name:IVEY
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9629 BUSTLETON AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-3833
Mailing Address - Country:US
Mailing Address - Phone:267-981-3578
Mailing Address - Fax:
Practice Address - Street 1:9629 BUSTLETON AVE APT 201
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3833
Practice Address - Country:US
Practice Address - Phone:267-981-3578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC014277101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional