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General NPI Number Information
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NPI Number | 1689309965
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Entity Type | Organization
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Legal Business Name | FREETOLIVE COUNSELING SERVICES
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Dates
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Enumeration Date | 07/20/2022
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 1515 MARKET ST STE 1200
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City | PHILADELPHIA
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State | PA
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Zip | 19102-1932
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Country | US
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Telephone | 484-496-4694
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Fax | 484-376-8005
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Provider Business Mailing Address
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Address Line | PO BOX 4662
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City | NEWARK
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State | DE
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Zip | 19715-4662
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Country | US
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Telephone | 484-496-4694
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Fax |
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Authorized Official
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Title or Position | LICENSED THERAPIST/OWNER
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Name | MRS. LATISHA D MCCOY
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Credential | PHD. LPC
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Telephone | 484-496-4694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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