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General NPI Number Information
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NPI Number | 1598038002
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Entity Type | Organization
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Legal Business Name | CULTIVATING WHOLENESS COUNSELING ASSOCIATES, PC
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Dates
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Enumeration Date | 02/14/2012
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Last Update Date | 02/14/2012
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Provider Practice Location Address
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Address Line | 8627 GERMANTOWN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19118-2839
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Country | US
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Telephone | 610-304-4782
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Fax |
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Provider Business Mailing Address
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Address Line | 8627 GERMANTOWN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19118-2839
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Country | US
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Telephone | 610-304-4782
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Fax |
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Authorized Official
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Title or Position | CEO/COUNSELING PSYCHOLOGIST
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Name | DR. YVONNE MARTINEZ THORNE
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Credential | ED.D.
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Telephone | 610-304-4782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PS016085
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License Number State | PA
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