Basic Information
| Provider Information | |||||||||
| NPI: | 1871877274 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DESMOND | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | ANDREW | ||||||||
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| Credential: | M.ED, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2672 ROUTE 119 HWY N | ||||||||
| Address2: | |||||||||
| City: | HOME | ||||||||
| State: | PA | ||||||||
| PostalCode: | 157478802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243884638 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1380 RTE 286 HWY E | ||||||||
| Address2: | SUITE 524 AIRPORT PROFESSIONAL CENTER | ||||||||
| City: | INDIANA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 157011461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7244650369 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2011 | ||||||||
| LastUpdateDate: | 02/02/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | PC009378 | PA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.