Organization
RAVERZEE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADA D WILSON BA (CEO)
(610) 876-1458
Entity
Organization
Contact information
Practice address
2 BALA PLZ, SUITE 300, BALA CYNWYD, PA 19004-1501
(610) 660-7779
(610) 660-7731
Mailing address
2 BALA PLZ, 300, BALA CYNWYD, PA 19004-1501
(610) 660-7779
(610) 660-7731
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
106H00000X
Marriage & Family Therapist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
467116
PA
Other
Enumeration date
07/07/2009
Last updated
12/03/2012
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