Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | PC006687 | PA |
NPI | 1003153511 |
---|---|
Provider Name | Thea Gallagher |
First Address | Langhorne, PA 19047-2215 |
Second Address | Newtown, PA 18940-3507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2013 |
Last Update Date | 04/01/2013 |