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General NPI Number Information
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NPI Number | 1417521972
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Entity Type | Organization
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Legal Business Name | EVERGROWING DEVELOPMENT CENTER
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Dates
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Enumeration Date | 05/18/2021
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 6703 GERMANTOWN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19119-2109
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Country | US
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Telephone | 215-687-7050
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4044
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City | PHILADELPHIA
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State | PA
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Zip | 19118-8044
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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 | DIRECTOR
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Name | LATRICE LEWIS
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Credential | MA, LPC
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Telephone | 215-776-6555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) 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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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