Healthcare Provider Details

I. General information

NPI: 1235981754
Provider Name (Legal Business Name): HUMAN CONNECTION COUNSELING COLLECTIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 DOROTHY RD
BROCKTON MA
02302-1123
US

IV. Provider business mailing address

1612 ALVARADO DR NE
ALBUQUERQUE NM
87110-6508
US

V. Phone/Fax

Practice location:
  • Phone: 781-817-3044
  • Fax: 781-468-3011
Mailing address:
  • Phone: 562-234-8411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. NICOLE GENEVIEVE AMARAL
Title or Position: OWNER
Credential: LMFT
Phone: 562-234-8411