Healthcare Provider Details

I. General information

NPI: 1437706835
Provider Name (Legal Business Name): WILLOW HOLISTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 BERKLEY RD STE 204
DEVON PA
19333-1381
US

IV. Provider business mailing address

45 BERKLEY RD STE 204
DEVON PA
19333-1381
US

V. Phone/Fax

Practice location:
  • Phone: 484-340-9586
  • Fax:
Mailing address:
  • Phone: 484-340-9586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CARRIE SENSENICH
Title or Position: OWNER, PSYCHOTHERAPIST
Credential: MSS, LCSW, CHT
Phone: 484-340-9586