Provider Demographics
NPI:1841614054
Name:CITYWIDE COMMUNITY COUNSELING SERVICES,
Entity Type:Organization
Organization Name:CITYWIDE COMMUNITY COUNSELING SERVICES,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF OPERATION
Authorized Official - Prefix:DR
Authorized Official - First Name:MODESTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-291-9500
Mailing Address - Street 1:5241 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124
Mailing Address - Country:US
Mailing Address - Phone:215-291-9500
Mailing Address - Fax:
Practice Address - Street 1:5241 JACKSON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124
Practice Address - Country:US
Practice Address - Phone:215-291-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health