Organization
THERAPY AND CONSULTATION SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK COTTOM LPC (OWNER)
(404) 918-6042
Entity
Organization
Contact information
Practice address
2000 SPRING GARDEN ST, 1 FRONT OFFICE, PHILADELPHIA, PA 19130-3994
(267) 330-0404
Mailing address
2000 SPRING GARDEN ST, 1 FRONT OFFICE, PHILADELPHIA, PA 19130-3994
(267) 330-0404
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
PC009399
PA
Other
Enumeration date
04/17/2017
Last updated
04/17/2017
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