Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 101YP2500X | Professional Counselor | PC007874 | PA |
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103TH0004X | Health Psychologist | ||
N | 103TH0004X | Health Psychologist | PC007874 | PA |
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1629374657 |
---|---|
Provider Name | Dr. Timothy Robert Test SR. |
First Address | Waynesboro, PA 17268-1874 |
Second Address | Waynesboro, PA 17268-1874 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2011 |
Last Update Date | 21/01/2015 |