MEDICARE: TLC WHOLENESS CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	PC002951	PA

General Provider Information

NPI Number	:	1851610125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TLC WHOLENESS CENTER

Provider Business Mailing Address
First Line	:	426 PENNSYLVANIA AVE
Second Line	:	STE 101
City	:	FT WASHINGTON
State	:	PA
Zip	:	19034-3410
Country	:	US
Telephone Number	:	215-620-7660
Fax Number	:	215-773-0789

Provider Business Practice Location Address
First Line	:	426 PENNSYLVANIA AVE
Second Line	:	STE 101
City	:	FT WASHINGTON
State	:	PA
Zip	:	19034-3410
Country	:	US
Telephone Number	:	215-620-7660
Fax Number	:	215-773-0789

Authorized Official
Title or Position	:	DIRECTOR LICENSED PROFESSIONAL COUN
Name	:	MS. ANN MARIE RUTH DEVIZIA
Credential	:	M.S. LPC
Telephone Number	:	215-620-7660

Provider Enumeration Date	:	05/25/2010
Last Update Date	:	05/25/2010

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Directions to “TLC WHOLENESS CENTER ” Practice Location

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