Provider Demographics
NPI:1992949036
Name:SELETZKY-DAVIDSON, JENNIFER (LPC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:SELETZKY-DAVIDSON
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 1:33 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-3502
Mailing Address - Country:US
Mailing Address - Phone:717-646-2955
Mailing Address - Fax:717-637-0124
Practice Address - Street 1:33 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-3502
Practice Address - Country:US
Practice Address - Phone:717-646-2955
Practice Address - Fax:717-637-0124
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003475101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional