Provider Demographics
NPI:1275239592
Name:WISE MIND THERAPEUTIC SERVICES LLC
Entity Type:Organization
Organization Name:WISE MIND THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:LILLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:484-641-8098
Mailing Address - Street 1:1103 ROCKY RD STE 202
Mailing Address - Street 2:
Mailing Address - City:WEST LAWN
Mailing Address - State:PA
Mailing Address - Zip Code:19609-1166
Mailing Address - Country:US
Mailing Address - Phone:484-640-8098
Mailing Address - Fax:610-750-5329
Practice Address - Street 1:1103 ROCKY RD STE 202
Practice Address - Street 2:
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609-1166
Practice Address - Country:US
Practice Address - Phone:484-641-8098
Practice Address - Fax:610-750-5329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty