Organization
DIAKON CHILD, FAMILY & COMMUNITY MINISTRIES
Active
Other names
Diakon Family Life Services
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RITA ROUSSEAU (EXECUTIVE DIRECTOR)
(717) 795-0368
Entity
Organization
Contact information
Practice address
435 W 4TH ST, WILLIAMSPORT, PA 17701-6001
(570) 322-7873
(570) 322-8026
Mailing address
435 W 4TH ST, WILLIAMSPORT, PA 17701-6001
(570) 322-7873
(570) 322-8026
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02319100
CAPITAL BLUE CROSS
PA
01
—
080465
FPH - PSYCHOLOGIST
PA
01
—
1443618
PA BLUE SHIELD - PSYCHOLO
PA
01
—
1526223
PA BLUE SHIELD - CRNP
PA
01
—
1808012
PA BS - LCSW FEP ONLY
PA
01
—
301029
VALUEOPTIONS
PA
01
—
716009
PA BLUE SHIELD - MD/DO
PA
01
—
803181
FIRST PRIORITY HEALTH
PA
Enumeration date
04/28/2014
Last updated
12/09/2014
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