Provider Demographics
NPI:1548570526
Name:COUNSELING CENTER AT HERITAGE, LLC
Entity Type:Organization
Organization Name:COUNSELING CENTER AT HERITAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:ROSETTA
Authorized Official - Last Name:PAONE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-997-7772
Mailing Address - Street 1:595 BETHLEHEM PIKE
Mailing Address - Street 2:SUITE 222
Mailing Address - City:MONTGOMERYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18936-9710
Mailing Address - Country:US
Mailing Address - Phone:215-997-7772
Mailing Address - Fax:215-434-7285
Practice Address - Street 1:595 BETHLEHEM PIKE
Practice Address - Street 2:SUITE 222
Practice Address - City:MONTGOMERYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18936-9710
Practice Address - Country:US
Practice Address - Phone:215-997-7772
Practice Address - Fax:215-434-7285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty