Individual
CARLY KOENIG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, NCC
Contact information
Practice address
4617 WOODLAND AVE, PHILADELPHIA, PA 19143-3836
(267) 254-0015
Mailing address
4617 WOODLAND AVE, PHILADELPHIA, PA 19143-3836
(609) 248-0631
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
04/22/2025
Last updated
06/16/2025
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