Healthcare Provider Details

I. General information

NPI: 1437876448
Provider Name (Legal Business Name): TWENTY-2 MANAGEMENT GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 10/21/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 EAGLEVIEW BLVD STE 120
EXTON PA
19341-1150
US

IV. Provider business mailing address

1564 TATTERSALL WAY
WEST CHESTER PA
19380-1594
US

V. Phone/Fax

Practice location:
  • Phone: 484-368-6978
  • Fax:
Mailing address:
  • Phone: 610-380-3351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
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: KENNETH SMITH
Title or Position: OWNER
Credential:
Phone: 484-368-6978