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General NPI Number Information
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NPI Number | 1558693168
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Entity Type | Organization
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Legal Business Name | GUIDANCE FOR GROWING, INC.
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Dates
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Enumeration Date | 02/06/2010
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Last Update Date | 02/06/2010
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Provider Practice Location Address
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Address Line | 121 N MAIN ST SUITE 108A
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City | SOUDERTON
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State | PA
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Zip | 18964-1715
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Country | US
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Telephone | 215-421-1634
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Fax |
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Provider Business Mailing Address
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Address Line | 121 N MAIN ST SUITE 108A
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City | SOUDERTON
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State | PA
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Zip | 18964-1715
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Country | US
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Telephone | 215-421-1634
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MICHAEL JASON RADOKSY
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Credential | L.C.S.W., C.A.C.
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Telephone | 215-421-1634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | CW016443
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License Number State | PA
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