Provider Demographics
NPI:1487974218
Name:DECARIA, DOMENIC (LPC)
Entity type:Individual
Prefix:
First Name:DOMENIC
Middle Name:
Last Name:DECARIA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046-5040
Mailing Address - Country:US
Mailing Address - Phone:717-272-5464
Mailing Address - Fax:717-273-1416
Practice Address - Street 1:128 N GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17401-1117
Practice Address - Country:US
Practice Address - Phone:717-848-6116
Practice Address - Fax:717-852-7580
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005524101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional