| Donnelle Super Counseling, Llc | |
|
4845 W Lake Rd Erie PA 16505-2961 | |
| (814) 881-5299 | |
| (814) 622-1017 |
| Full Name | Donnelle Super Counseling, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4845 W Lake Rd, Erie, Pennsylvania |
| Authorized Official Name and Position | Donnelle Super (OWNER) |
| Authorized Official Contact | 8148815299 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Donnelle Super Counseling, Llc 5971 Teller Rd Girard PA 16417-9112 Ph: (814) 881-5299 | Donnelle Super Counseling, Llc 4845 W Lake Rd Erie PA 16505-2961 Ph: (814) 881-5299 |
| NPI Number | 1770347577 |
|---|---|
| Provider Enumeration Date | 02/12/2024 |
| Last Update Date | 07/11/2024 |
| Certification Date | 04/03/2024 |
| Medicare PECOS PAC ID | 0042656936 |
|---|---|
| Medicare Enrollment ID | O20240314000232 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770347577 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Donnelle Super |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508231283 PECOS PAC ID: 2860840063 Enrollment ID: I20240314000207 |
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