Provider Demographics
NPI:1851610125
Name:TLC WHOLENESS CENTER
Entity Type:Organization
Organization Name:TLC WHOLENESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR LICENSED PROFESSIONAL COUN
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN MARIE
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:DEVIZIA
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPC
Authorized Official - Phone:215-620-7660
Mailing Address - Street 1:426 PENNSYLVANIA AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:FT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-3410
Mailing Address - Country:US
Mailing Address - Phone:215-620-7660
Mailing Address - Fax:215-773-0789
Practice Address - Street 1:426 PENNSYLVANIA AVE
Practice Address - Street 2:STE 101
Practice Address - City:FT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3410
Practice Address - Country:US
Practice Address - Phone:215-620-7660
Practice Address - Fax:215-773-0789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002951101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty