Provider Demographics
NPI:1639823750
Name:ATHA, RAEGAN
Entity type:Individual
Prefix:
First Name:RAEGAN
Middle Name:
Last Name:ATHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RAEGAN
Other - Middle Name:
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1214 WEST END AVENUE
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036
Mailing Address - Country:US
Mailing Address - Phone:717-531-8520
Mailing Address - Fax:
Practice Address - Street 1:1214 WEST END AVENUE
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036
Practice Address - Country:US
Practice Address - Phone:717-531-8520
Practice Address - Fax:717-531-8520
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program