Provider Demographics
NPI:1629549928
Name:PURPOSEFULLY SOARING COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:PURPOSEFULLY SOARING COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, NCC, LPC
Authorized Official - Phone:717-400-1871
Mailing Address - Street 1:4512 BOLTON NOTCH PL
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3414
Mailing Address - Country:US
Mailing Address - Phone:412-708-7482
Mailing Address - Fax:
Practice Address - Street 1:1537 DEVONSHIRE RD
Practice Address - Street 2:SUITE G
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112
Practice Address - Country:US
Practice Address - Phone:717-400-1871
Practice Address - Fax:717-814-5260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-12
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3832975OtherHIGHMARK
PA601259189OtherMAGELLAN