Provider Demographics
NPI:1154698165
Name:WEAVER, KAY L (BCBC)
Entity type:Individual
Prefix:MRS
First Name:KAY
Middle Name:L
Last Name:WEAVER
Suffix:
Gender:F
Credentials:BCBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 HOUSTON RUN DRIVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:GAP
Mailing Address - State:PA
Mailing Address - Zip Code:17527
Mailing Address - Country:US
Mailing Address - Phone:717-442-9577
Mailing Address - Fax:717-442-9672
Practice Address - Street 1:835 HOUSTON RUN DRIVE
Practice Address - Street 2:SUITE 230
Practice Address - City:GAP
Practice Address - State:PA
Practice Address - Zip Code:17527
Practice Address - Country:US
Practice Address - Phone:717-442-9577
Practice Address - Fax:717-442-9672
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral