Provider Demographics
NPI:1871877274
Name:DESMOND, JAMES ANDREW (MED, LPC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ANDREW
Last Name:DESMOND
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2672 ROUTE 119 HWY N
Mailing Address - Street 2:
Mailing Address - City:HOME
Mailing Address - State:PA
Mailing Address - Zip Code:15747-8802
Mailing Address - Country:US
Mailing Address - Phone:724-388-4638
Mailing Address - Fax:
Practice Address - Street 1:1380 RTE 286 HWY E
Practice Address - Street 2:SUITE 524 AIRPORT PROFESSIONAL CENTER
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-1461
Practice Address - Country:US
Practice Address - Phone:724-465-0369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009378101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health