Organization
MID RIVER COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINICK AGOSTI LCSW (MEMBER)
(717) 417-8378
Entity
Organization
Contact information
Practice address
416 MARKET ST STE 214, LEWISBURG, PA 17837-1473
(717) 417-8378
Mailing address
416 MARKET ST STE 214, LEWISBURG, PA 17837-1473
(717) 417-8378
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1437765435
INDIVIDUAL NPI
PA
Enumeration date
04/17/2025
Last updated
04/21/2025
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