Provider Demographics
NPI:1568012557
Name:SOUTH PINE COUNSELING LLC
Entity Type:Organization
Organization Name:SOUTH PINE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARDYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-909-0984
Mailing Address - Street 1:20 SOUTH PINE STREET
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-4691
Mailing Address - Country:US
Mailing Address - Phone:215-550-1796
Mailing Address - Fax:
Practice Address - Street 1:20 SOUTH PINE STREET
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-4691
Practice Address - Country:US
Practice Address - Phone:215-550-1796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-12
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty