Provider Demographics
NPI:1629404728
Name:MAIN LINE COUNSELING & WELLNESS CENTER, INC
Entity Type:Organization
Organization Name:MAIN LINE COUNSELING & WELLNESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:610-664-2524
Mailing Address - Street 1:104 1/2 FORREST AVE
Mailing Address - Street 2:SUITE 27
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-2220
Mailing Address - Country:US
Mailing Address - Phone:610-664-2524
Mailing Address - Fax:
Practice Address - Street 1:104 1/2 FORREST AVE
Practice Address - Street 2:SUITE 27
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-2220
Practice Address - Country:US
Practice Address - Phone:610-664-2524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006228101YP2500X
PACW0172611041C0700X
PACW0173111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty