Provider Demographics
NPI:1801506324
Name:HICKORY CREEK COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:HICKORY CREEK COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERG-GRALA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC, CADC
Authorized Official - Phone:717-864-8446
Mailing Address - Street 1:950 WALNUT BOTTOM RD STE 15
Mailing Address - Street 2:#190
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015
Mailing Address - Country:US
Mailing Address - Phone:717-864-8446
Mailing Address - Fax:717-876-6423
Practice Address - Street 1:401 E LOUTHER ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-2657
Practice Address - Country:US
Practice Address - Phone:717-864-8446
Practice Address - Fax:717-876-6423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty