Healthcare Provider Details

I. General information

NPI: 1790697829
Provider Name (Legal Business Name): MATTIE CHOI
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

124 DEKALB PIKE STE 2
NORTH WALES PA
19454-1853
US

IV. Provider business mailing address

104 DEVON CT
NORTH WALES PA
19454-1424
US

V. Phone/Fax

Practice location:
  • Phone: 215-701-2932
  • Fax: 267-762-4368
Mailing address:
  • Phone: 215-272-7883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC002793
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: