Provider Demographics
NPI:1215310198
Name:MAIN, ELIZABETH (MA, BCC, NCC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MAIN
Suffix:
Gender:F
Credentials:MA, BCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251A CHERRY ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17315-2451
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3920 MARKET ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4202
Practice Address - Country:US
Practice Address - Phone:717-730-2144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health