Provider Demographics
NPI:1265802292
Name:SAID, ATHENA (LPC)
Entity type:Individual
Prefix:
First Name:ATHENA
Middle Name:
Last Name:SAID
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:PO BOX 288
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-0288
Mailing Address - Country:US
Mailing Address - Phone:570-620-4311
Mailing Address - Fax:570-620-4332
Practice Address - Street 1:105 TERRACE DR STE 102
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-7510
Practice Address - Country:US
Practice Address - Phone:570-620-4311
Practice Address - Fax:570-620-4332
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-02
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008230101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional