Provider Demographics
NPI:1720623770
Name:ACHIEVING TRUE SELF
Entity type:Organization
Organization Name:ACHIEVING TRUE SELF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTOSICKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-287-2036
Mailing Address - Street 1:8865 NORWIN AVE STE 27
Mailing Address - Street 2:
Mailing Address - City:NORTH HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-2769
Mailing Address - Country:US
Mailing Address - Phone:866-287-2036
Mailing Address - Fax:888-244-1718
Practice Address - Street 1:5100 BUCKEYSTOWN PIKE STE 250
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-8344
Practice Address - Country:US
Practice Address - Phone:866-287-2036
Practice Address - Fax:888-244-1718
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACHIEVING TRUE SELF
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health