Healthcare Provider Details

I. General information

NPI: 1275925059
Provider Name (Legal Business Name): TRICHIA TAMICA PRINCE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 DOWLIN FORGE RD
EXTON PA
19341-1548
US

IV. Provider business mailing address

91 DOWLIN FORGE RD
EXTON PA
19341-1548
US

V. Phone/Fax

Practice location:
  • Phone: 610-363-7115
  • Fax: 610-363-7116
Mailing address:
  • Phone: 610-363-7115
  • Fax: 610-363-7116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW131812
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: