Provider Demographics
NPI:1447439054
Name:CUMBERLAND VALLEY COUNSELING ASSOCIATES PC
Entity type:Organization
Organization Name:CUMBERLAND VALLEY COUNSELING ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:PEHL
Authorized Official - Last Name:MINNIX
Authorized Official - Suffix:
Authorized Official - Credentials:MS,LICENSED PSYCH
Authorized Official - Phone:717-243-1511
Mailing Address - Street 1:1200 WALNUT BOTTOM RD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-7766
Mailing Address - Country:US
Mailing Address - Phone:717-243-1511
Mailing Address - Fax:717-243-1530
Practice Address - Street 1:1200 WALNUT BOTTOM RD
Practice Address - Street 2:SUITE 311
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-7766
Practice Address - Country:US
Practice Address - Phone:717-243-1511
Practice Address - Fax:717-243-1530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003026101YP2500X
PAPS006810-L103TC0700X
PACW0130341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty