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General NPI Number Information
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NPI Number | 1053748939
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Entity Type | Organization
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Legal Business Name | EVERGREEN COUNSELING AND PSYCHOLOGICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 10/08/2013
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 8705 GERMANTOWN AVE STE 3
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City | PHILADELPHIA
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State | PA
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Zip | 19118-2720
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Country | US
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Telephone | 215-247-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 8705 GERMANTOWN AVE STE 3
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City | PHILADELPHIA
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State | PA
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Zip | 19118-2720
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Country | US
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Telephone | 215-247-5400
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. CHRISTINE MCGUIRE
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Credential | PSY.D.
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Telephone | 215-247-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS016945
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License Number State | PA
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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