| NPI | 1114144508 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAKISA S GALLMAN Administrative Director 215-276-3922 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA 192780) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA 192780) |
| 103TC0700X Psychologist, Clinical (Licence: PA 192780) | |
| 174400000X Specialist (Licence: PA 192780) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2020-08-22 |