Healthcare Provider Details

I. General information

NPI: 1669291464
Provider Name (Legal Business Name): WILDFLOWER ROAD COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 PLEASANT ST STE 108
ARLINGTON MA
02476-6532
US

IV. Provider business mailing address

PO BOX 550044
NORTH WALTHAM MA
02455-0044
US

V. Phone/Fax

Practice location:
  • Phone: 508-596-3357
  • Fax:
Mailing address:
  • Phone: 508-596-3357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MOLLY WEINBERG
Title or Position: OWNER
Credential:
Phone: 508-596-3357