Organization
EVERGREEN COUNSELING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY SULT MS, LPC (LICENSED PROFESSIONAL COUNSELOR)
(717) 658-0885
Entity
Organization
Contact information
Practice address
20A BEECH ST, CARLISLE, PA 17013-3105
(814) 244-3072
Mailing address
18608 WILDERNESS WAY, HAGERSTOWN, MD 21740-3123
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
PC007703
PA
Other
Enumeration date
08/15/2018
Last updated
09/11/2018
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