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1000 Commerce Park Drive, Suite 307 Williamsport PA 17701-5474 | |
| (570) 220-6270 | |
| (272) 202-5097 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1000 Commerce Park Drive, Suite 307, Williamsport, Pennsylvania |
| Authorized Official Name and Position | Pamela Wollet Wollet (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 5702206270 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
267 Fluman Road Williamsport PA 17701-8588 Ph: (570) 220-6270 | 1000 Commerce Park Drive, Suite 307 Williamsport PA 17701-5474 Ph: (570) 220-6270 |
| NPI Number | 1376280362 |
|---|---|
| Provider Enumeration Date | 05/19/2022 |
| Last Update Date | 07/13/2023 |
| Certification Date | 07/13/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376280362 | NPI | - | NPPES |
| 1034909730002 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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