Provider Demographics
NPI:1639375512
Name:KRESOVICH, AMBER DIACK (LPC)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:DIACK
Last Name:KRESOVICH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 ARCHERS GLEN RD
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-6457
Mailing Address - Country:US
Mailing Address - Phone:814-571-6620
Mailing Address - Fax:
Practice Address - Street 1:111 S SPRING ST
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823
Practice Address - Country:US
Practice Address - Phone:814-933-5335
Practice Address - Fax:814-470-8744
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007780101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC007780OtherLPC LICENSE