Provider Demographics
NPI:1306354774
Name:OBILO-AZANDEGBE, PATRICIA (LPC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:OBILO-AZANDEGBE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HAVERFORD RD STE 201
Mailing Address - Street 2:
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041-1139
Mailing Address - Country:US
Mailing Address - Phone:610-664-2524
Mailing Address - Fax:
Practice Address - Street 1:30 S VALLEY RD STE 101
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301
Practice Address - Country:US
Practice Address - Phone:610-664-2524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009604101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional