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General NPI Number Information
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NPI Number | 1619641255
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Entity Type | Organization
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Legal Business Name | THE DANTZLER HOUSE
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Dates
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Enumeration Date | 08/06/2021
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Last Update Date | 11/15/2021
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Provider Practice Location Address
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Address Line | 2449 GOLF RD
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City | PHILADELPHIA
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State | PA
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Zip | 19131-1475
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Country | US
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Telephone | 267-346-5088
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Fax |
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Provider Business Mailing Address
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Address Line | 2449 GOLF RD
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City | PHILADELPHIA
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State | PA
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Zip | 19131-1475
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Country | US
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Telephone | 267-685-6096
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. SHANAYA DANTZLER
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Credential | LPC
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Telephone | 267-346-5088
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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 |
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License Number State |
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