MEDICARE: SAMARITAN COUNSELING CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1487617973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMARITAN COUNSELING CENTER

Provider Business Mailing Address
First Line	:	22 E CHESTNUT HILL AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-2715
Country	:	US
Telephone Number	:	215-247-6077
Fax Number	:	215-247-4158

Provider Business Practice Location Address
First Line	:	22 E CHESTNUT HILL AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-2715
Country	:	US
Telephone Number	:	215-247-6077
Fax Number	:	215-247-4158

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. PAMELA J HOLLIMAN
Credential	:	PHD
Telephone Number	:	215-247-6077

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	08/22/2020

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