Provider Demographics
NPI:1841967585
Name:INDIGO LIFE COUNSELING
Entity type:Organization
Organization Name:INDIGO LIFE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:YOLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:484-201-9797
Mailing Address - Street 1:4628 BROADWAY # 1003A
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-3200
Mailing Address - Country:US
Mailing Address - Phone:484-244-4712
Mailing Address - Fax:
Practice Address - Street 1:2542 GREEN ACRES DR
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-3740
Practice Address - Country:US
Practice Address - Phone:484-244-4712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-29
Last Update Date:2021-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty