| Theodoredis Counseling Llc | |
|
2045 Westgate Dr Ste 206 Bethlehem PA 18017-7475 | |
| (610) 730-3422 | |
| Not Available |
| Full Name | Theodoredis Counseling Llc |
|---|---|
| Speciality | Counselor |
| Location | 2045 Westgate Dr Ste 206, Bethlehem, Pennsylvania |
| Authorized Official Name and Position | Stan Theodoredis (OWNER) |
| Authorized Official Contact | 6105964222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Theodoredis Counseling Llc 2045 Westgate Dr Ste 206 Bethlehem PA 18017-7475 Ph: (610) 596-4222 | Theodoredis Counseling Llc 2045 Westgate Dr Ste 206 Bethlehem PA 18017-7475 Ph: (610) 730-3422 |
| NPI Number | 1528579471 |
|---|---|
| Provider Enumeration Date | 10/18/2017 |
| Last Update Date | 01/24/2023 |
| Certification Date | 01/24/2023 |
| Medicare PECOS PAC ID | 2567711963 |
|---|---|
| Medicare Enrollment ID | O20180817002034 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528579471 | NPI | - | NPPES |
| CAQH | Other | 14097224 | |
| 009228 | Other | LICNESE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Melissa Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134981848 PECOS PAC ID: 0547603185 Enrollment ID: I20240209003313 |
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