Doctor Name: | MS. LORI A WATERS |
NPI Number: | 1063429207 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC CAC |
License Number: | PC000590 |
Business Practice Address: | 141 E Fairmount Ave State College, PA - 16801 |
Business Phone Number: | 8142343464 |
Business Fax Number: | 8142376646 |
Mailing Address: | 141 E Fairmount Ave, STATE COLLEGE |
State: | PA |
Postal Code: | 16801 |
Phone Number: | 8142343464 |
Fax Number: | 8142376646 |
NPI Enumeration Date: | 08/01/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | PC000590 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |