Provider Demographics
NPI:1386020204
Name:PHILADELPHIA COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:PHILADELPHIA COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MESVESKAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-298-1999
Mailing Address - Street 1:25 BALA AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3213
Mailing Address - Country:US
Mailing Address - Phone:610-298-1999
Mailing Address - Fax:267-262-6733
Practice Address - Street 1:25 BALA AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3213
Practice Address - Country:US
Practice Address - Phone:610-298-1999
Practice Address - Fax:267-262-6733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder