Healthcare Provider Details

I. General information

NPI: 1245715531
Provider Name (Legal Business Name): TINA EFE OKORO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 WOODLAND AVE
PHILADELPHIA PA
19143-5607
US

IV. Provider business mailing address

1401 S 31ST ST FL 2
PHILADELPHIA PA
19146-3506
US

V. Phone/Fax

Practice location:
  • Phone: 215-724-4700
  • Fax: 215-724-3111
Mailing address:
  • Phone: 215-724-4700
  • Fax: 215-724-3111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: