Provider Demographics
NPI:1306968649
Name:DESTEFANO, C KATHERINE (LPC)
Entity type:Individual
Prefix:
First Name:C KATHERINE
Middle Name:
Last Name:DESTEFANO
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 1:120 FOXSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-3982
Mailing Address - Country:US
Mailing Address - Phone:717-431-6615
Mailing Address - Fax:717-618-0498
Practice Address - Street 1:120 FOXSHIRE DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-3982
Practice Address - Country:US
Practice Address - Phone:717-431-6615
Practice Address - Fax:717-618-0498
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004069101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022575990002Medicaid
PA1018958650004Medicaid