Healthcare Provider Details

I. General information

NPI: 1366794505
Provider Name (Legal Business Name): WEISE COUNSELING COLLABORATIVE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 LUDLOW ST
BELCHERTOWN MA
01007-8807
US

IV. Provider business mailing address

160 LUDLOW ST
BELCHERTOWN MA
01007-8807
US

V. Phone/Fax

Practice location:
  • Phone: 413-687-9685
  • Fax:
Mailing address:
  • Phone: 413-687-9685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116365
License Number StateMA

VIII. Authorized Official

Name: MELISSA DOROTHY WEISE
Title or Position: DIRECTOR, PRESIDENT
Credential: MSW, LICSW
Phone: 413-687-9685