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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
3609 N BROAD ST, PHILADELPHIA, PA 19140-4107
(215) 223-3600
(215) 223-2100
Mailing address
3609 N BROAD ST, PHILADELPHIA, PA 19140-4107
(215) 223-3600
(215) 223-2100
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
192780
PA
101YP2500X
Professional Counselor
Primary
192780
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016804930006
—
PA
Enumeration date
04/19/2007
Last updated
09/11/2025
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