Healthcare Provider Details

I. General information

NPI: 1760727408
Provider Name (Legal Business Name): GROWTH OPPORTUNITY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 JAYMOR RD B150
SOUTHAMPTON PA
18966
US

IV. Provider business mailing address

928 JAYMORE RD B150
SOUTHAMPTON PA
18966
US

V. Phone/Fax

Practice location:
  • Phone: 215-947-8654
  • Fax: 215-938-7607
Mailing address:
  • Phone: 215-947-8654
  • Fax: 215-938-7607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPC005707
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JUDITH MORRISSEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 215-947-8654