Healthcare Provider Details

I. General information

NPI: 1962014936
Provider Name (Legal Business Name): TJOCELYNE COUNSELING & CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 PLEASANT ST STE 102
BROCKTON MA
02301-2533
US

IV. Provider business mailing address

425 PLEASANT ST STE 102
BROCKTON MA
02301-2533
US

V. Phone/Fax

Practice location:
  • Phone: 508-580-0364
  • Fax: 888-506-6021
Mailing address:
  • Phone: 508-580-0364
  • Fax: 888-506-6021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TAMARRA J ARISTILDE-CALIXTE
Title or Position: CEO
Credential: LMFT
Phone: 774-269-2459