Healthcare Provider Details

I. General information

NPI: 1033661350
Provider Name (Legal Business Name): GLEN MILLS COUNSELING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 BALTIMORE PIKE SUITE 3
GLEN MILLS PA
19342-1074
US

IV. Provider business mailing address

736 BALTIMORE PIKE
GLEN MILLS PA
19342-1074
US

V. Phone/Fax

Practice location:
  • Phone: 610-656-1424
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW017215
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: THERESA AGOSTINELLI
Title or Position: OWNER
Credential:
Phone: 610-656-1424