Healthcare Provider Details

I. General information

NPI: 1386556439
Provider Name (Legal Business Name): WILLIMINA TETA WORDSWORTH VI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 SENECA ST
LESTER PA
19029-1604
US

IV. Provider business mailing address

774 E PROVIDENCE RD APT C216
ALDAN PA
19018-4354
US

V. Phone/Fax

Practice location:
  • Phone: 215-325-4174
  • Fax:
Mailing address:
  • Phone: 215-327-4174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBH008465
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: