Healthcare Provider Details

I. General information

NPI: 1265834766
Provider Name (Legal Business Name): THE WHOLENESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 OAK ST STE C
BROCKTON MA
02301-1303
US

IV. Provider business mailing address

1367 MAIN ST
BROCKTON MA
02301-7111
US

V. Phone/Fax

Practice location:
  • Phone: 508-580-3800
  • Fax: 508-580-3805
Mailing address:
  • Phone: 508-580-3800
  • Fax: 508-580-3805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberS50130595
License Number StateMA

VIII. Authorized Official

Name: SANDRA GARCON
Title or Position: OWNER
Credential: LICSW
Phone: 508-580-3800