Organization
DIAKON LUTHERAN SOCIAL MINISTRIES
Active
Other names
Family Life Services
Organization subpart
No
Provider details
NPI number
Authorized official
RITA A. ROUSSEAU (EXECUTIVE DIRECTOR COS)
(717) 795-0368
Entity
Organization
Contact information
Practice address
1600 FOWLER AVE, BERWICK, PA 18603-1423
(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
101YM0800X
Mental Health Counselor
Primary
356240
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02319100
CAPITAL BLUE CROSS
PA
05
—
1007777400038
—
PA
01
—
301029
VALUEOPTIONS
PA
Enumeration date
06/22/2006
Last updated
08/22/2020
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