1548843121 NPI number — CICELY CALVARESI-HOLSTON LPC

Table of content: CICELY CALVARESI-HOLSTON LPC (NPI 1548843121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548843121 NPI number — CICELY CALVARESI-HOLSTON LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALVARESI-HOLSTON
Provider First Name:
CICELY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CICELY HOLSTON COUNSELING
Provider Other First Name:
PHOENIX WELLNESS LLC
Provider Other Middle Name:
DBS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1548843121
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1209 WHITFIELD BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
READING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19609-1138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-222-8282
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 WOODLAND RD LOWR LEVEL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYOMISSING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19610-1999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-222-8282
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  PC016640 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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