Organization
GENTLE FORCE WELLNESS TREATMENT FACILITY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTOINETTE BOGAN MS, LBS, LPC, NCC (CEO)
(215) 987-4662
Entity
Organization
Contact information
Practice address
1626 LOCUS STREET, PHILADELPHIA, PA 19103
(215) 987-4662
Mailing address
1626 LOCUS STREET, PHILADELPHIA, PA 19103
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
163WC1500X
Community Health Registered Nurse
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
01/02/2024
Last updated
07/01/2024
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