| NPI | 1417733916 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE MARCUS GILLIAM Psychotherapist 215-839-6867 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2023-08-31 |
| Last Update Date | 2023-08-31 |