Healthcare Provider Details

I. General information

NPI: 1619669389
Provider Name (Legal Business Name): WOVEN ROOTS INTEGRATIVE THERAPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2432 AVONDALE AVE
ABINGTON PA
19001-4203
US

IV. Provider business mailing address

2432 AVONDALE AVE
ABINGTON PA
19001-4203
US

V. Phone/Fax

Practice location:
  • Phone: 336-207-5354
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: EMILY REICHNER
Title or Position: CO-OWNER
Credential: LCSW
Phone: 336-207-5354