Individual
HENRY KYLE WEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2514 N BROAD ST, PHILADELPHIA, PA 19132-4013
(215) 432-9689
Mailing address
419 N 67TH ST, PHILADELPHIA, PA 19151-4008
(215) 432-9689
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
12/21/2017
Last updated
12/21/2017
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