Organization
EARTH WITNESS THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER MOORE LCSW (OWNER)
(445) 895-1544
Entity
Organization
Contact information
Practice address
1355 S MARKOE ST, PHILADELPHIA, PA 19143-3811
(445) 895-1544
Mailing address
1355 S MARKOE ST, PHILADELPHIA, PA 19143-3811
(732) 890-4141
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
06/18/2024
Last updated
06/18/2024
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