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General NPI Number Information
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NPI Number | 1275980187
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Entity Type | Organization
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Legal Business Name | MA'AT THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 05/20/2016
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Last Update Date | 05/20/2016
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Provider Practice Location Address
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Address Line | 6228 GREENE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19144-2618
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Country | US
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Telephone | 215-275-4117
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Fax |
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Provider Business Mailing Address
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Address Line | 6228 GREENE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19144-2618
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Country | US
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Telephone | 215-275-4117
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Fax | 267-385-6008
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Authorized Official
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Title or Position | OWNER
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Name | NZINGHA MA'AT
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Credential | MS, LPC
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Telephone | 215-275-4117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC004165
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License Number State | PA
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