Provider Demographics
NPI:1871260869
Name:HART, DESIREE NICOLE (LPC)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:NICOLE
Last Name:HART
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 1:24727 ROUTE 6 STE 2
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-8257
Mailing Address - Country:US
Mailing Address - Phone:570-265-0100
Mailing Address - Fax:570-268-2756
Practice Address - Street 1:24727 ROUTE 6 STE 2
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-8257
Practice Address - Country:US
Practice Address - Phone:570-265-0100
Practice Address - Fax:570-268-2756
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013242101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional