Provider Demographics
NPI:1598038002
Name:CULTIVATING WHOLENESS COUNSELING ASSOCIATES, PC
Entity Type:Organization
Organization Name:CULTIVATING WHOLENESS COUNSELING ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/COUNSELING PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ THORNE
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:610-304-4782
Mailing Address - Street 1:8627 GERMANTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-2839
Mailing Address - Country:US
Mailing Address - Phone:610-304-4782
Mailing Address - Fax:
Practice Address - Street 1:8627 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-2839
Practice Address - Country:US
Practice Address - Phone:610-304-4782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016085103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty