Provider Demographics
NPI:1821522574
Name:WEST SHORE WELLNESS
Entity Type:Organization
Organization Name:WEST SHORE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:BUPP
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NCC, CAADC
Authorized Official - Phone:717-301-4044
Mailing Address - Street 1:20 S 36TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-4355
Mailing Address - Country:US
Mailing Address - Phone:717-301-4044
Mailing Address - Fax:
Practice Address - Street 1:20 S 36TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4355
Practice Address - Country:US
Practice Address - Phone:717-301-4044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009582101YA0400X, 101YM0800X, 101YP2500X, 405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty