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Organization
WMC
Active
Organization
WMC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAKISA S GALLMAN (ADMINISTRATIVE DIRECTOR)
(215) 276-3922
Entity
Organization
Contact information
Practice address
1939 S JUNIPER ST, PHILADELPHIA, PA 19148-2217
(215) 271-5822
(215) 271-5881
Mailing address
1939 S JUNIPER ST, PHILADELPHIA, PA 19148-2217
(215) 271-5822
(215) 271-5881
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
192780
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016804930002
—
PA
05
—
0016804930004
—
PA
Enumeration date
04/19/2007
Last updated
08/22/2020
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