Individual
PETA XAVIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, LBS
Contact information
Practice address
239 S BUTLER RD, LEBANON, PA 17042-8939
(717) 270-2422
Mailing address
601 MEMORY LN, YORK, PA 17402-2231
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
PC019839
PA
101YP2500X
Professional Counselor
Primary
PC019839
PA
103K00000X
Behavior Analyst
Primary
BH001357
PA
174400000X
Specialist
BH001357
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14917473
CAQH
—
01
—
BH001357
STATE LICENSE
PA
01
—
PC019839
COUNSELING
PA
Enumeration date
05/19/2020
Last updated
05/01/2026
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