| Its Mine Movement, Inc | |
|
1440 Conchester Hwy Ste 8a Garnet Valley PA 19060-2105 | |
| (215) 258-9110 | |
| (215) 258-8588 |
| Full Name | Its Mine Movement, Inc |
|---|---|
| Speciality | Counselor |
| Location | 1440 Conchester Hwy Ste 8a, Garnet Valley, Pennsylvania |
| Authorized Official Name and Position | Camilla Aminah James (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2679018612 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Its Mine Movement, Inc 701 E Cathedral Rd Ste 45-1395 Philadelphia PA 19128-2128 Ph: (267) 766-6060 | Its Mine Movement, Inc 1440 Conchester Hwy Ste 8a Garnet Valley PA 19060-2105 Ph: (215) 258-9110 |
| NPI Number | 1922672005 |
|---|---|
| Provider Enumeration Date | 05/13/2021 |
| Last Update Date | 12/24/2024 |
| Certification Date | 12/24/2024 |
| Medicare PECOS PAC ID | 0840690616 |
|---|---|
| Medicare Enrollment ID | O20210616000131 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922672005 | NPI | - | NPPES |
| 103965593 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Angelica Maria Thorne |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699429464 PECOS PAC ID: 4183153067 Enrollment ID: I20250122000567 |
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