Healthcare Provider Details

I. General information

NPI: 1518466804
Provider Name (Legal Business Name): HARBOR CHRISTIAN COUNSELING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 PROSPECT ST
CAMBRIDGE MA
02139-2505
US

IV. Provider business mailing address

19 LOVELL RD
MELROSE MA
02176-1301
US

V. Phone/Fax

Practice location:
  • Phone: 617-299-6516
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW WARREN
Title or Position: DIRECTOR
Credential:
Phone: 617-299-6516