Basic Information
| Provider Information | |||||||||
| NPI: | 1952470825 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KROL | ||||||||
| FirstName: | HENRY | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | LPC CAC DIPLOMATE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2910 STATE STREET | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144545686 | ||||||||
| FaxNumber: | 8144548946 | ||||||||
| Practice Location | |||||||||
| Address1: | 2910 STATE STREET | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144545686 | ||||||||
| FaxNumber: | 8144548946 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | PC002807 | PA | X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | PC002807 | PA | X | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 1641336 | 01 | PA | HIGHMARK | OTHER |