Individual
MR. MICHAEL ALLEN IDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
562 WYOMING AVENUE, CHOICES, KINGSTON, PA 18704
(570) 552-3700
(570) 552-3705
Mailing address
2005 SANDERSON AVENUE, SCRANTON, PA 18509
(570) 266-1635
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
104100000X
Social Worker
Primary
SW129791
PA
Other
Enumeration date
05/29/2008
Last updated
08/17/2017
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