Provider Demographics
NPI:1528579471
Name:THEODOREDIS COUNSELING LLC
Entity Type:Organization
Organization Name:THEODOREDIS COUNSELING LLC
Other - Org Name:LEHIGH VALLEY COUNSELORS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THEODOREDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-596-4222
Mailing Address - Street 1:2045 WESTGATE DR STE 206
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7475
Mailing Address - Country:US
Mailing Address - Phone:610-596-4222
Mailing Address - Fax:
Practice Address - Street 1:2045 WESTGATE DR STE 206
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7475
Practice Address - Country:US
Practice Address - Phone:610-730-3422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQHOther14097224
009228OtherLICNESE