Provider Demographics
NPI:1598088734
Name:CHILD AND ADOLESCENT COUNSELING SERVICES OF SOUTHEASTERN PA.
Entity type:Organization
Organization Name:CHILD AND ADOLESCENT COUNSELING SERVICES OF SOUTHEASTERN PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:VAN DER LAAN
Authorized Official - Suffix:
Authorized Official - Credentials:MHS, CAC, CCJS
Authorized Official - Phone:484-769-9109
Mailing Address - Street 1:220 W GAY ST
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-2917
Mailing Address - Country:US
Mailing Address - Phone:610-764-8655
Mailing Address - Fax:
Practice Address - Street 1:220 W GAY ST
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-2917
Practice Address - Country:US
Practice Address - Phone:610-764-8655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2314101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty