Basic Information
Provider Information
NPI: 1003007410
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: UNDERKOFFLER
FirstName: ADRIENNE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.A.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 32
Address2: 807 LAWN AVENUE
City: SELLERSVILLE
State: PA
PostalCode: 18960
CountryCode: US
TelephoneNumber: 2152576551
FaxNumber: 2152574008
Practice Location
Address1: 807 LAWN AVENUE
Address2:  
City: SELLERSVILLE
State: PA
PostalCode: 18960
CountryCode: US
TelephoneNumber: 2152576551
FaxNumber: 2152574008
Other Information
ProviderEnumerationDate: 08/09/2007
LastUpdateDate: 09/17/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YA0400X  Y Behavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
171M00000X  N Other Service ProvidersCase Manager/Care Coordinator 

No ID Information.


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