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Organization
RECHARGE YOUR LIFE LLC
Active
Organization
RECHARGE YOUR LIFE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COLLEEN ANNMARIE GENSEMER LPC (OWNER)
(484) 269-6572
Entity
Organization
Contact information
Practice address
845 N PARK RD, WYOMISSING, PA 19610-1342
(484) 269-6752
Mailing address
845 N PARK RD, WYOMISSING, PA 19610-1342
(484) 269-6752
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PC004498
LPC LICENSE
PA
Enumeration date
08/12/2019
Last updated
08/12/2019
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