Provider Demographics
NPI:1548843121
Name:CALVARESI-HOLSTON, CICELY (LPC)
Entity type:Individual
Prefix:
First Name:CICELY
Middle Name:
Last Name:CALVARESI-HOLSTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:PHOENIX WELLNESS LLC
Other - Middle Name:DBS
Other - Last Name:CICELY HOLSTON COUNSELING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1209 WHITFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19609-1138
Mailing Address - Country:US
Mailing Address - Phone:484-222-8282
Mailing Address - Fax:
Practice Address - Street 1:2 WOODLAND RD LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1999
Practice Address - Country:US
Practice Address - Phone:484-222-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC016640101YP2500X
101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)