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General NPI Number Information
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NPI Number | 1003510975
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Entity Type | Organization
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Legal Business Name | WELLNESS SUPPORT COUNSELING, LLC
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Dates
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Enumeration Date | 03/27/2023
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 270 W WALNUT LN # 2D
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City | PHILADELPHIA
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State | PA
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Zip | 19144-3204
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Country | US
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Telephone | 215-399-6215
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Fax |
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Provider Business Mailing Address
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Address Line | 6830 WAYNE AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19119-3422
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | PATRICK GRUGAN
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Credential | LCSW
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Telephone | 215-399-6215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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