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General NPI Number Information
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NPI Number | 1780043844
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Entity Type | Organization
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Legal Business Name | EFFECTIVE INTERPERSONAL COUNSELING SERVICES
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Dates
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Enumeration Date | 02/17/2016
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Last Update Date | 02/17/2016
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Provider Practice Location Address
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Address Line | 1522B GREGG ST
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City | PHILADELPHIA
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State | PA
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Zip | 19115-4283
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Country | US
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Telephone | 215-698-1978
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Fax |
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Provider Business Mailing Address
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Address Line | 1522B GREGG ST
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City | PHILADELPHIA
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State | PA
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Zip | 19115-4283
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Country | US
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Telephone | 215-698-1978
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JONATHAN MICHAEL CLARK
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Credential | LPC, NCC
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Telephone | 215-698-1978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 6339902
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License Number State | PA
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