Provider Demographics
NPI:1811392723
Name:CARMEN ROYALL COUNSELING
Entity type:Organization
Organization Name:CARMEN ROYALL COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROYALL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:610-743-3404
Mailing Address - Street 1:33 W LANCASTER AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-1898
Mailing Address - Country:US
Mailing Address - Phone:610-743-3404
Mailing Address - Fax:610-743-8619
Practice Address - Street 1:33 W LANCASTER AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-1898
Practice Address - Country:US
Practice Address - Phone:610-743-3404
Practice Address - Fax:610-743-8619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002477101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102682500001Medicaid
PA1114002490OtherNPI