Provider Demographics
NPI:1134599608
Name:PHILLY FAMILY LIFE COUNSELING, LLC
Entity type:Organization
Organization Name:PHILLY FAMILY LIFE COUNSELING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER OF LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:215-554-8191
Mailing Address - Street 1:1209 GRANT AVE
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-3706
Mailing Address - Country:US
Mailing Address - Phone:215-677-3710
Mailing Address - Fax:215-673-2701
Practice Address - Street 1:1209 GRANT AVE
Practice Address - Street 2:SUITE 2F
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3706
Practice Address - Country:US
Practice Address - Phone:215-677-3710
Practice Address - Fax:215-673-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty