Provider Demographics
NPI:1619468097
Name:CHANGE OF HEART COUNSELING AND CONSULTATION SERVICES, INC
Entity Type:Organization
Organization Name:CHANGE OF HEART COUNSELING AND CONSULTATION SERVICES, INC
Other - Org Name:ALISHIA ALLEGRUCCI, LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALISHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEGRUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:570-840-0831
Mailing Address - Street 1:66 TOMPKINSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SCOTT TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18433-7889
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 HUNTER HWY STE 2
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-8064
Practice Address - Country:US
Practice Address - Phone:570-840-0831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty