Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | PC010357 | PA |
Y | 101YP2500X | Professional Counselor | PC010357 | PA |
NPI | 1003230244 |
---|---|
Provider Name | Tina Presbery |
First Address | Philadelphia, PA 19149-2525 |
Second Address | Philadelphia, PA 19149-2525 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2014 |
Last Update Date | 11/12/2018 |