Doctor Name: | MRS. ANTONIA VASILAKIS |
NPI Number: | 1295779411 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS ATR BC LPC |
License Number: | PC003621 |
Business Practice Address: | 2421 Willow Street Pike Willow Street, PA - 17584 |
Business Phone Number: | 7174641450 |
Business Fax Number: | 7174640890 |
Mailing Address: | 2421 Willow Street Pike, WILLOW STREET |
State: | PA |
Postal Code: | 17584 |
Phone Number: | 7174641450 |
Fax Number: | 7174640890 |
NPI Enumeration Date: | 06/16/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | PC003621 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |