Organization
GREEN RIVER COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVENING SHINEROCK LCSW (MANAGER)
(603) 801-7543
Entity
Organization
Contact information
Practice address
701 S 50TH ST FL 3, PHILADELPHIA, PA 19143-1689
(347) 470-9084
Mailing address
5024 CATHARINE ST, PHILADELPHIA, PA 19143-1628
(603) 801-7543
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
11/20/2023
Last updated
11/20/2023
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