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General NPI Number Information
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NPI Number | 1477126415
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Entity Type | Organization
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Legal Business Name | SYNCHRONICITY, LLC/BEWELL
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Dates
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Enumeration Date | 07/19/2021
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Last Update Date | 07/19/2021
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Provider Practice Location Address
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Address Line | 6812 PECHIN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19128-4425
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Country | US
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Telephone | 267-290-1123
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Fax |
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Provider Business Mailing Address
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Address Line | 6812 PECHIN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19128-4425
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Country | US
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Telephone | 267-290-1123
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Fax |
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Authorized Official
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Title or Position | CO-FOUNDER/PSYCHOTHERAPIST
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Name | SHAAKIRA GILLETTE
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Credential | LCSW
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Telephone | 267-290-1123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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